Provider First Line Business Practice Location Address:
3280 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-2266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-599-3338
Provider Business Practice Location Address Fax Number:
304-599-2623
Provider Enumeration Date:
08/23/2005