Provider First Line Business Practice Location Address:
4605 MACCORKLE AVE SW
Provider Second Line Business Practice Location Address:
THOMAS HOSPITAL DIABETES CENTER
Provider Business Practice Location Address City Name:
SOUTH CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25309-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-766-5616
Provider Business Practice Location Address Fax Number:
304-766-3796
Provider Enumeration Date:
12/09/2011