Provider First Line Business Practice Location Address:
U.S. ROUTE 250 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPPI
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26416-0055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-457-2037
Provider Business Practice Location Address Fax Number:
304-457-2056
Provider Enumeration Date:
11/17/2006