Provider First Line Business Practice Location Address:
RR 3 BOX 457A
Provider Second Line Business Practice Location Address:
HINKLE RD.
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25840-9776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-574-1090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2008