Provider First Line Business Practice Location Address:
1902 15TH AVENUE
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:
26101-6121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-236-1407
Provider Business Practice Location Address Fax Number:
740-236-1664
Provider Enumeration Date:
01/30/2007