Provider First Line Business Practice Location Address:
76 FERRELL LAWSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPMANVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25508-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-688-9732
Provider Business Practice Location Address Fax Number:
304-855-5544
Provider Enumeration Date:
12/12/2011