Provider First Line Business Practice Location Address:
4 HOSPITAL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301-9327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-1966
Provider Business Practice Location Address Fax Number:
304-293-6963
Provider Enumeration Date:
09/22/2006