Provider First Line Business Practice Location Address:
20 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601-3452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-831-1138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006