Provider First Line Business Practice Location Address:
16130 WEBSTER RD.
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:
26205-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-742-3570
Provider Business Practice Location Address Fax Number:
304-742-3572
Provider Enumeration Date:
10/30/2006