Provider First Line Business Practice Location Address:
9998 FRANKFORT HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT ASHBY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-298-4443
Provider Business Practice Location Address Fax Number:
304-298-4443
Provider Enumeration Date:
07/27/2006