Provider First Line Business Practice Location Address:
663 CENTRAL AVE
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:
25504-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-6878
Provider Business Practice Location Address Fax Number:
304-691-5743
Provider Enumeration Date:
04/13/2006