Provider First Line Business Practice Location Address:
3200 MACCORKLE AVE SE
Provider Second Line Business Practice Location Address:
DEPT OF BEHAVIORAL MEDICINE, 5TH FLOOR
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-388-1029
Provider Business Practice Location Address Fax Number:
304-388-1041
Provider Enumeration Date:
08/01/2010