Provider First Line Business Practice Location Address:
1601 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNDSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26041-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-2330
Provider Business Practice Location Address Fax Number:
304-845-2397
Provider Enumeration Date:
09/21/2005