Provider First Line Business Practice Location Address:
4900 SMITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICHARD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-486-5051
Provider Business Practice Location Address Fax Number:
304-486-5648
Provider Enumeration Date:
07/18/2005