Provider First Line Business Practice Location Address:
OFF RT 19 - ST. BARBARAS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONONGAH
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-534-5220
Provider Business Practice Location Address Fax Number:
304-534-4041
Provider Enumeration Date:
09/15/2005