Provider First Line Business Practice Location Address:
717 N JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-645-2525
Provider Business Practice Location Address Fax Number:
304-645-2820
Provider Enumeration Date:
07/31/2006