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Certified Provider Details:
| PROVIDER NUMBER: | 490083 |
| AGENCY NAME: | Davis Stuart, Inc. |
| CONTACT NAME: | Joe Collins |
| ADDRESS: | RR 2 Box 188A |
| CITY: | Lewisburg |
| STATE: | WV |
| ZIP: | 24901 |
| PHONE: | (304) 647-5577 ext. 337 |
| WEB SITE: | |
| EMAIL ADDRESS: | collinsj@davis-stuart.org |
| BSW/MSW NAME: | Phillip Jerman |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |