Provider First Line Business Practice Location Address:
556 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPMANVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-549-1139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2008