Provider First Line Business Practice Location Address:
130 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANSTED
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25812-0520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-658-5940
Provider Business Practice Location Address Fax Number:
304-658-5941
Provider Enumeration Date:
02/12/2008