Provider First Line Business Practice Location Address:
54 COLLEGE AVENUE
Provider Second Line Business Practice Location Address:
BOX 1746
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-473-8349
Provider Business Practice Location Address Fax Number:
304-473-8349
Provider Enumeration Date:
02/22/2013