Provider First Line Business Practice Location Address:
3400 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:
26104-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-428-0946
Provider Business Practice Location Address Fax Number:
304-428-9598
Provider Enumeration Date:
01/10/2012