Provider First Line Business Practice Location Address:
416 OLD BLUEFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-0384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-487-1661
Provider Business Practice Location Address Fax Number:
304-487-1848
Provider Enumeration Date:
12/01/2005