Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
ORAL/MAXILLOFACIAL SURGERY, HEALTH SCIENCE CTR
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506-9475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-2841
Provider Business Practice Location Address Fax Number:
304-293-3674
Provider Enumeration Date:
06/26/2009