Provider First Line Business Practice Location Address:
300 S. PRICE ST
Provider Second Line Business Practice Location Address:
C/O PRESTON MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-329-1400
Provider Business Practice Location Address Fax Number:
304-329-1175
Provider Enumeration Date:
06/27/2006