Provider First Line Business Practice Location Address:
HC 82 BOX 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24901-9501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-645-6080
Provider Business Practice Location Address Fax Number:
304-645-2825
Provider Enumeration Date:
09/16/2005