Provider First Line Business Practice Location Address:
98 BALL SCHOOL RD
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:
26101-7431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-210-2481
Provider Business Practice Location Address Fax Number:
304-485-6406
Provider Enumeration Date:
10/09/2020