Provider First Line Business Practice Location Address:
RR 1 BOX 332
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POINT PLEASANT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25550-9726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-675-1612
Provider Business Practice Location Address Fax Number:
304-675-1657
Provider Enumeration Date:
12/14/2006