Provider First Line Business Practice Location Address:
6351 US ROUTE 60 E
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-9232
Provider Business Practice Location Address Fax Number:
304-736-9220
Provider Enumeration Date:
09/28/2010