Provider First Line Business Practice Location Address:
126 12TH 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:
26070-1572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-737-0205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2011