Provider First Line Business Practice Location Address:
1300 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-292-1764
Provider Business Practice Location Address Fax Number:
304-292-1769
Provider Enumeration Date:
08/02/2005