Provider First Line Business Practice Location Address:
6349 US ROUTE 60 E
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-733-7642
Provider Business Practice Location Address Fax Number:
304-721-8889
Provider Enumeration Date:
05/05/2008