Provider First Line Business Practice Location Address:
RT 20 PROFESSIONAL ARTS PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-0551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-6393
Provider Business Practice Location Address Fax Number:
304-472-6485
Provider Enumeration Date:
10/04/2006