Provider First Line Business Practice Location Address:
1021 MAIN ST
Provider Second Line Business Practice Location Address:
MANCHIN CLINIC 3RD FLR
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26571-0510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-825-6004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006