Provider First Line Business Practice Location Address:
201 RITCHIE COUNTY SCHOOL RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENBORO
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26346-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-869-3526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2013