Provider First Line Business Practice Location Address:
1421 COMMERCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26070-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-737-3425
Provider Business Practice Location Address Fax Number:
304-737-2610
Provider Enumeration Date:
05/17/2006