Provider First Line Business Practice Location Address:
1600 27TH 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:
26101-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-485-6476
Provider Business Practice Location Address Fax Number:
304-485-1306
Provider Enumeration Date:
11/19/2012