Provider First Line Business Practice Location Address:
20 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601-3452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-831-1070
Provider Business Practice Location Address Fax Number:
304-831-1071
Provider Enumeration Date:
07/19/2017