Provider First Line Business Practice Location Address:
448 LEONARD AVE.
Provider Second Line Business Practice Location Address:
VALLEY HEALTHCARE SYSTEM
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-296-1731
Provider Business Practice Location Address Fax Number:
304-225-2288
Provider Enumeration Date:
09/19/2012