Provider First Line Business Practice Location Address:
70 BROOKSHIRE LANE
Provider Second Line Business Practice Location Address:
BLAYDES CLINIC
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:
304-994-0719
Provider Business Practice Location Address Fax Number:
304-241-1858
Provider Enumeration Date:
02/07/2014