Provider First Line Business Practice Location Address:
1215 AVERY ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-865-7505
Provider Business Practice Location Address Fax Number:
304-865-0233
Provider Enumeration Date:
04/18/2012