Provider First Line Business Practice Location Address:
4 HOSPITAL PLAZA
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-7421
Provider Business Practice Location Address Fax Number:
304-624-7619
Provider Enumeration Date:
04/28/2006