Provider First Line Business Practice Location Address:
RT 20 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-0715
Provider Business Practice Location Address Fax Number:
304-472-6251
Provider Enumeration Date:
07/10/2006