Provider First Line Business Practice Location Address:
174 LMAH CENTER RD
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:
25601-4058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-792-7130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2023