Provider First Line Business Practice Location Address:
659 CENTRAL AVE
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:
25504-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-5247
Provider Business Practice Location Address Fax Number:
304-736-5768
Provider Enumeration Date:
04/03/2006