Provider First Line Business Practice Location Address:
6467 FARMDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-2050
Provider Business Practice Location Address Fax Number:
304-736-3570
Provider Enumeration Date:
09/23/2006