Provider First Line Business Practice Location Address:
312 6TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SOUTH CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25303-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-744-4532
Provider Business Practice Location Address Fax Number:
304-744-3219
Provider Enumeration Date:
06/27/2006