Provider First Line Business Practice Location Address:
420 PLEASANT HILL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAR CITY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-599-0513
Provider Business Practice Location Address Fax Number:
304-599-0671
Provider Enumeration Date:
09/21/2006