Provider First Line Business Practice Location Address:
1226 SHEPHERDSTOWN ROAD
Provider Second Line Business Practice Location Address:
FAIRVIEW DENTAL BLDG
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-267-2928
Provider Business Practice Location Address Fax Number:
304-267-0720
Provider Enumeration Date:
10/05/2006