Provider First Line Business Practice Location Address:
68 GOOD SAMARITAN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26807-0700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-358-2320
Provider Business Practice Location Address Fax Number:
304-358-3746
Provider Enumeration Date:
07/08/2005