Provider First Line Business Practice Location Address:
600 18TH ST
Provider Second Line Business Practice Location Address:
STE 404
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:
304-424-4650
Provider Business Practice Location Address Fax Number:
304-424-4681
Provider Enumeration Date:
07/26/2010