Provider First Line Business Practice Location Address:
3903 EMERSON AVE
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:
26104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-424-7343
Provider Business Practice Location Address Fax Number:
304-424-7373
Provider Enumeration Date:
10/10/2006