Provider First Line Business Practice Location Address:
648 CANOE BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPMANVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25508-7330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-316-7068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2026