Provider First Line Business Practice Location Address:
3552 ROUTE 60 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-733-9560
Provider Business Practice Location Address Fax Number:
304-733-1141
Provider Enumeration Date:
12/18/2006