Provider First Line Business Practice Location Address:
805 JOHNSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-929-3945
Provider Business Practice Location Address Fax Number:
304-929-3945
Provider Enumeration Date:
09/22/2006