Provider First Line Business Practice Location Address:
7355 US RT 152
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-6473
Provider Business Practice Location Address Fax Number:
304-522-6477
Provider Enumeration Date:
12/05/2006