Provider First Line Business Practice Location Address:
RT 219 OLD SCHOOL HOUSE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDSIDE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-753-4384
Provider Business Practice Location Address Fax Number:
304-753-9886
Provider Enumeration Date:
05/16/2007