Provider First Line Business Practice Location Address:
9013 TEAYS VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT DEPOT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25560-7700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-755-1769
Provider Business Practice Location Address Fax Number:
855-843-9349
Provider Enumeration Date:
03/30/2020