Provider First Line Business Practice Location Address:
66 FARMDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-453-4992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2024