Provider First Line Business Practice Location Address:
117 S FAYETTE 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:
25801-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-255-2931
Provider Business Practice Location Address Fax Number:
304-255-0222
Provider Enumeration Date:
11/09/2005