Provider First Line Business Practice Location Address:
744 LAMBERT BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENOA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25517-7403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-972-2644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2026