Provider First Line Business Practice Location Address:
1000 S MAPLEWOOD DR
Provider Second Line Business Practice Location Address:
C/O EMERITUS AT MAPLEWOOD
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26330-9593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-933-3338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2015