Provider First Line Business Practice Location Address:
STATE ROUTE 20 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24712-0915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-384-9805
Provider Business Practice Location Address Fax Number:
304-384-8817
Provider Enumeration Date:
09/22/2006