Provider First Line Business Practice Location Address:
1417 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLLANSBEE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26037-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-527-1670
Provider Business Practice Location Address Fax Number:
304-527-1672
Provider Enumeration Date:
08/10/2005