Provider First Line Business Practice Location Address:
142 EAST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPENCER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-927-1697
Provider Business Practice Location Address Fax Number:
304-927-3298
Provider Enumeration Date:
06/29/2007