Provider First Line Business Practice Location Address:
109 WAR MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY SPRINGS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25411-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-788-1285
Provider Business Practice Location Address Fax Number:
304-788-2194
Provider Enumeration Date:
12/13/2005