Provider First Line Business Practice Location Address:
1212 GARFIELD AVE STE 202
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:
26101-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-865-3611
Provider Business Practice Location Address Fax Number:
302-577-2169
Provider Enumeration Date:
05/24/2005