Provider First Line Business Practice Location Address:
122 WEDGEWOOD DR
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:
26104-9229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-482-7997
Provider Business Practice Location Address Fax Number:
304-485-8629
Provider Enumeration Date:
01/23/2013