Provider First Line Business Practice Location Address:
149 JERRY WEST HWY STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601-3967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-752-5100
Provider Business Practice Location Address Fax Number:
304-250-3685
Provider Enumeration Date:
07/07/2014