Provider First Line Business Practice Location Address:
3427 US 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:
304-736-8255
Provider Business Practice Location Address Fax Number:
304-736-4851
Provider Enumeration Date:
10/19/2006