Provider First Line Business Practice Location Address:
MAIN ST AND PERRY DR.
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
CHAPMANVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-855-7104
Provider Business Practice Location Address Fax Number:
304-855-1125
Provider Enumeration Date:
06/29/2006