Provider First Line Business Practice Location Address:
1110 20TH ST
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:
26101-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-485-3834
Provider Business Practice Location Address Fax Number:
304-422-4911
Provider Enumeration Date:
11/27/2007