Provider First Line Business Practice Location Address:
600 18TH ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-424-4961
Provider Business Practice Location Address Fax Number:
314-424-4861
Provider Enumeration Date:
10/03/2006