Provider First Line Business Practice Location Address:
4113 TEAYS VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT DEPOT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25560-9740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-201-7645
Provider Business Practice Location Address Fax Number:
304-757-3840
Provider Enumeration Date:
10/02/2006