Provider First Line Business Practice Location Address:
102 N. COURT ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CUMBERLAND
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-564-3343
Provider Business Practice Location Address Fax Number:
304-564-3410
Provider Enumeration Date:
11/20/2006