Provider First Line Business Practice Location Address:
1531 GARFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-893-9484
Provider Business Practice Location Address Fax Number:
304-893-9485
Provider Enumeration Date:
07/11/2006