Provider First Line Business Practice Location Address:
247 HARRISON AVE.
Provider Second Line Business Practice Location Address:
COUNTY OF MORGAN
Provider Business Practice Location Address City Name:
BERKELEY SPRINGS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25411-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-258-2014
Provider Business Practice Location Address Fax Number:
304-267-3599
Provider Enumeration Date:
10/05/2007