Provider First Line Business Practice Location Address:
2311 OHIO AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-422-5114
Provider Business Practice Location Address Fax Number:
304-422-5751
Provider Enumeration Date:
06/09/2005