Provider First Line Business Practice Location Address:
3540 ROUTE 60 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-733-5355
Provider Business Practice Location Address Fax Number:
304-733-9743
Provider Enumeration Date:
07/25/2008