Provider First Line Business Practice Location Address:
RR 1 BOX 55
Provider Second Line Business Practice Location Address:
CLAYLICK ROAD
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25271-9709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-372-2848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2008