Provider First Line Business Practice Location Address:
221 EIGHTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLINTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-799-0815
Provider Business Practice Location Address Fax Number:
304-799-0809
Provider Enumeration Date:
09/28/2006