Provider First Line Business Practice Location Address:
63 CARR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25043-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-587-4232
Provider Business Practice Location Address Fax Number:
304-587-2092
Provider Enumeration Date:
10/18/2006