Provider First Line Business Practice Location Address:
3501 EMERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26104-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-422-1106
Provider Business Practice Location Address Fax Number:
304-422-1128
Provider Enumeration Date:
06/24/2006