Provider First Line Business Practice Location Address:
111 FAYETTE AVENUE
Provider Second Line Business Practice Location Address:
FAYETTE COUNTY SCHOOLS
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-574-1176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2016