Provider First Line Business Practice Location Address:
12 TH STREET EXT.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-487-7265
Provider Business Practice Location Address Fax Number:
304-487-7132
Provider Enumeration Date:
05/23/2007