Provider First Line Business Practice Location Address:
140 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH CHARLESTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-342-4422
Provider Business Practice Location Address Fax Number:
304-400-4986
Provider Enumeration Date:
10/16/2013