Provider First Line Business Practice Location Address:
422 23RD STREET
Provider Second Line Business Practice Location Address:
HIDDEN VALLEY CENTER
Provider Business Practice Location Address City Name:
OAKHILL
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-465-1903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007