Provider First Line Business Practice Location Address:
203 BRADFORD STREET
Provider Second Line Business Practice Location Address:
PIEDMONT ELEMENTARY
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-348-1910
Provider Business Practice Location Address Fax Number:
304-469-2674
Provider Enumeration Date:
03/23/2007