Provider First Line Business Practice Location Address:
422 DIVISION STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-485-7487
Provider Business Practice Location Address Fax Number:
304-485-5410
Provider Enumeration Date:
11/02/2006