Provider First Line Business Practice Location Address:
1021 QUARRIER STREET
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BUILDING SUITE 517
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-345-7272
Provider Business Practice Location Address Fax Number:
304-345-7287
Provider Enumeration Date:
03/22/2007