Provider First Line Business Practice Location Address:
705 GARFIELD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-424-2030
Provider Business Practice Location Address Fax Number:
304-424-2956
Provider Enumeration Date:
11/21/2006