Provider First Line Business Practice Location Address:
2014 DUDLEY AVE
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:
26101-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-422-1841
Provider Business Practice Location Address Fax Number:
304-865-0592
Provider Enumeration Date:
07/28/2011