Provider First Line Business Practice Location Address:
1824 MURDOCH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-3230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-422-6576
Provider Business Practice Location Address Fax Number:
304-485-4466
Provider Enumeration Date:
09/23/2005