Provider First Line Business Practice Location Address:
PO BOX 9238 HSCS, 64 MEDICAL ENTER DR, WEST VIRGINIA
Provider Second Line Business Practice Location Address:
UNIV SCH OF MEDICINE, DEPT OF SURGERY RM 7320
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506-9238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-1254
Provider Business Practice Location Address Fax Number:
304-293-4711
Provider Enumeration Date:
05/13/2026