Provider First Line Business Practice Location Address:
72 RED OAK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRAIGSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26205-0729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-742-5200
Provider Business Practice Location Address Fax Number:
304-742-5214
Provider Enumeration Date:
12/05/2005