Provider First Line Business Practice Location Address:
PROFESSIOAL ARTS PLAZA SUITE A
Provider Second Line Business Practice Location Address:
PROFESSIONAL SRTS PLAZA SUITE A
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-7386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-1776
Provider Business Practice Location Address Fax Number:
304-473-1060
Provider Enumeration Date:
10/26/2007