Provider First Line Business Practice Location Address:
546 ROUTE 20 SOUTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-2774
Provider Business Practice Location Address Fax Number:
304-472-3927
Provider Enumeration Date:
03/16/2007