Provider First Line Business Practice Location Address:
110 MORDINGTON AVENUE
Provider Second Line Business Practice Location Address:
JEFFERSON COUNTY BOARD OF EDUCATION
Provider Business Practice Location Address City Name:
CHARLES TOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-267-3595
Provider Business Practice Location Address Fax Number:
304-267-3599
Provider Enumeration Date:
10/27/2009