Provider First Line Business Practice Location Address:
206 SPRUCE STREET
Provider Second Line Business Practice Location Address:
TUCKER VA CLINIC
Provider Business Practice Location Address City Name:
PARSONS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-478-2219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006