Provider First Line Business Practice Location Address:
3121 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-599-2159
Provider Business Practice Location Address Fax Number:
304-599-4408
Provider Enumeration Date:
12/26/2006