Provider First Line Business Practice Location Address:
1006 COMMERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26070-1567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-737-4435
Provider Business Practice Location Address Fax Number:
304-737-4439
Provider Enumeration Date:
06/22/2005