Provider First Line Business Practice Location Address:
2301 CAMDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-5610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-972-6568
Provider Business Practice Location Address Fax Number:
304-861-5352
Provider Enumeration Date:
09/23/2011