Provider First Line Business Practice Location Address:
289 CRAWLEY CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPMANVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-855-9502
Provider Business Practice Location Address Fax Number:
304-855-9505
Provider Enumeration Date:
11/07/2006