Provider First Line Business Practice Location Address:
715 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-9441
Provider Business Practice Location Address Fax Number:
304-736-1984
Provider Enumeration Date:
07/21/2005