Provider First Line Business Practice Location Address:
2012 GARFIELD AVE STE 3
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:
26101-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-893-9100
Provider Business Practice Location Address Fax Number:
304-893-9103
Provider Enumeration Date:
12/03/2014