Provider First Line Business Practice Location Address:
100 A HUNTINGTON MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSFILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-4129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-9550
Provider Business Practice Location Address Fax Number:
304-733-0584
Provider Enumeration Date:
11/13/2006