Provider First Line Business Practice Location Address:
101 LOGAN ST.
Provider Second Line Business Practice Location Address:
MEMORIAL BLDG BASEMENT
Provider Business Practice Location Address City Name:
WILLIAMSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-235-0426
Provider Business Practice Location Address Fax Number:
304-235-2295
Provider Enumeration Date:
01/12/2023