Provider First Line Business Practice Location Address:
1246 KANAWHA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNBAR
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25064-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-389-0402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006