Provider First Line Business Practice Location Address:
128 RIGHT FORK NEWCOMB CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25570-5182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-272-5224
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2025