Provider First Line Business Practice Location Address:
6446 FARMDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-733-9781
Provider Business Practice Location Address Fax Number:
304-733-9782
Provider Enumeration Date:
05/02/2007