Provider First Line Business Practice Location Address:
RT 1 BOX 123 ANTHONY CREEK ROAD
Provider Second Line Business Practice Location Address:
.
Provider Business Practice Location Address City Name:
FRANKFORD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24938-0097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-497-2752
Provider Business Practice Location Address Fax Number:
304-497-2752
Provider Enumeration Date:
01/04/2007