Provider First Line Business Practice Location Address:
129 EAST GERMAN STREET
Provider Second Line Business Practice Location Address:
ROOM 210
Provider Business Practice Location Address City Name:
SHEPHERDSTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25443-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-876-3766
Provider Business Practice Location Address Fax Number:
304-876-8431
Provider Enumeration Date:
12/29/2006