Provider First Line Business Practice Location Address:
3605 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19543-8910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-286-6222
Provider Business Practice Location Address Fax Number:
610-286-6278
Provider Enumeration Date:
06/27/2007