Provider First Line Business Practice Location Address:
346 S FLORIDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-2452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-3280
Provider Business Practice Location Address Fax Number:
304-472-6805
Provider Enumeration Date:
07/18/2005