Provider First Line Business Practice Location Address:
1223 WASHINGTON ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-345-2944
Provider Business Practice Location Address Fax Number:
304-345-2957
Provider Enumeration Date:
11/03/2005