Provider First Line Business Practice Location Address:
326 ROUTE 20 SOUTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-8963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-2433
Provider Business Practice Location Address Fax Number:
304-472-2453
Provider Enumeration Date:
01/03/2007