Provider First Line Business Practice Location Address:
CROSS CREEK RD RR#3
Provider Second Line Business Practice Location Address:
BROOKE HIGH SCHOOL
Provider Business Practice Location Address City Name:
WELLSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26070-1961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-527-1410
Provider Business Practice Location Address Fax Number:
304-527-3604
Provider Enumeration Date:
01/03/2008