Provider First Line Business Practice Location Address:
211 S CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-5212
Provider Business Practice Location Address Fax Number:
304-623-5812
Provider Enumeration Date:
06/21/2006