Provider First Line Business Practice Location Address:
117 W WAGNER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENBORO
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26346-0328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-869-3888
Provider Business Practice Location Address Fax Number:
304-869-3444
Provider Enumeration Date:
06/27/2023