Provider First Line Business Practice Location Address:
STATE ROUTE 79 CABIN CREEK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAWES
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25054-0070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-595-5065
Provider Business Practice Location Address Fax Number:
304-595-2936
Provider Enumeration Date:
12/08/2006