Provider First Line Business Practice Location Address:
3000 HAMPTON CTR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-599-5000
Provider Business Practice Location Address Fax Number:
304-599-6629
Provider Enumeration Date:
12/13/2006