Provider First Line Business Practice Location Address:
213 1/2 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNDSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26041-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-830-6002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2026