Provider First Line Business Practice Location Address:
2150 CHILDRESS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALUM CREEK
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25003-0040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-756-9001
Provider Business Practice Location Address Fax Number:
304-756-2081
Provider Enumeration Date:
12/28/2007