Provider First Line Business Practice Location Address:
314 PINE STREET
Provider Second Line Business Practice Location Address:
PENDELTON COMMUNITY CARE
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26807-0100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-358-2355
Provider Business Practice Location Address Fax Number:
304-358-3054
Provider Enumeration Date:
08/10/2006