Provider First Line Business Practice Location Address:
1512 COMMERCE ST
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:
26070-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-737-2964
Provider Business Practice Location Address Fax Number:
304-737-4882
Provider Enumeration Date:
11/02/2006