Provider First Line Business Practice Location Address:
10164 FRANKFORT HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT ASHBY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26719-9221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-298-4404
Provider Business Practice Location Address Fax Number:
304-298-4184
Provider Enumeration Date:
01/27/2012