Provider First Line Business Practice Location Address:
150 PATRICK HENRY WAY
Provider Second Line Business Practice Location Address:
CHARLES TOWN PLAZA
Provider Business Practice Location Address City Name:
CHARLES TOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25414-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-267-2599
Provider Business Practice Location Address Fax Number:
304-267-1530
Provider Enumeration Date:
12/30/2008