Provider First Line Business Practice Location Address:
186 NORTH SPRING STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-0395
Provider Business Practice Location Address Fax Number:
304-472-4673
Provider Enumeration Date:
10/11/2006