Provider First Line Business Practice Location Address:
1500 LAFAYETTE AVE
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:
26041-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-0908
Provider Business Practice Location Address Fax Number:
304-810-0654
Provider Enumeration Date:
06/23/2006