Provider First Line Business Practice Location Address:
14 E. FAIRMONT ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-534-8227
Provider Business Practice Location Address Fax Number:
304-534-3535
Provider Enumeration Date:
11/01/2006