Provider First Line Business Practice Location Address:
640 SCHOOL HOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SETH
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25181-9496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-928-6973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2025