Provider First Line Business Practice Location Address:
113 LB&T WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601-3485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-752-2535
Provider Business Practice Location Address Fax Number:
304-752-2707
Provider Enumeration Date:
07/27/2007