Provider First Line Business Practice Location Address:
64
Provider Second Line Business Practice Location Address:
MEDICAL CENTER DR
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506-9465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-4703
Provider Business Practice Location Address Fax Number:
304-293-7649
Provider Enumeration Date:
01/30/2006