Provider First Line Business Practice Location Address:
1900 GARFIELD AVE
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-422-9862
Provider Business Practice Location Address Fax Number:
304-428-9527
Provider Enumeration Date:
08/18/2008