Provider First Line Business Practice Location Address:
RR #1 BOX 414
Provider Second Line Business Practice Location Address:
COLUMBIA ANCILLARY SERVICES INC
Provider Business Practice Location Address City Name:
MOUNT CLARE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-622-2635
Provider Business Practice Location Address Fax Number:
304-622-2271
Provider Enumeration Date:
12/28/2006