Provider First Line Business Practice Location Address:
ROUTE 10
Provider Second Line Business Practice Location Address:
OLD ITMANN GRADE SCHOOL
Provider Business Practice Location Address City Name:
ITMANN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-294-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007