Provider First Line Business Practice Location Address:
149 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:
25276-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-927-5112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2005