Provider First Line Business Practice Location Address:
16810 WEBSTER RD.
Provider Second Line Business Practice Location Address:
PO DRAWER 730
Provider Business Practice Location Address City Name:
CRAIGSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26205-0730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-742-6202
Provider Business Practice Location Address Fax Number:
304-742-6280
Provider Enumeration Date:
06/19/2008