Provider First Line Business Practice Location Address:
101 SOUTH MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPMANVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-855-3535
Provider Business Practice Location Address Fax Number:
304-855-3535
Provider Enumeration Date:
08/21/2006