Provider First Line Business Practice Location Address:
3 HEALTHCARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPPI
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26416-9405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-457-0063
Provider Business Practice Location Address Fax Number:
304-457-4011
Provider Enumeration Date:
10/22/2009