Provider First Line Business Practice Location Address:
ROUTE 10 THREE MILE CURVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-752-2273
Provider Business Practice Location Address Fax Number:
304-752-4167
Provider Enumeration Date:
06/21/2006