Provider First Line Business Practice Location Address:
RT 92 S JENNMAR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-864-6446
Provider Business Practice Location Address Fax Number:
304-864-6447
Provider Enumeration Date:
08/08/2008