Provider First Line Business Practice Location Address:
605 NORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-643-4040
Provider Business Practice Location Address Fax Number:
304-643-5090
Provider Enumeration Date:
10/03/2006