Provider First Line Business Practice Location Address:
1961 PRICKETTS CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554-6284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-276-4785
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2026