Provider First Line Business Practice Location Address:
117 BACK FORK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER SPRINGS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26288-1032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-847-5151
Provider Business Practice Location Address Fax Number:
304-847-2800
Provider Enumeration Date:
10/09/2005