Provider First Line Business Practice Location Address:
1204 S KANAWHA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-252-5676
Provider Business Practice Location Address Fax Number:
304-252-5645
Provider Enumeration Date:
12/28/2006