Provider First Line Business Practice Location Address:
216 W NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26362-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-643-5399
Provider Business Practice Location Address Fax Number:
304-643-5398
Provider Enumeration Date:
08/01/2006