Provider First Line Business Practice Location Address:
6007 US ROUTE 60 E
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-0825
Provider Business Practice Location Address Fax Number:
304-736-3199
Provider Enumeration Date:
10/17/2006