Provider First Line Business Practice Location Address:
77 HOSPITAL DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-896-5200
Provider Business Practice Location Address Fax Number:
304-896-5300
Provider Enumeration Date:
07/17/2008