Provider First Line Business Practice Location Address:
2500 MEADOWBROOK MALL
Provider Second Line Business Practice Location Address:
JC PENNEY OPTICAL
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26330-9792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-842-8515
Provider Business Practice Location Address Fax Number:
214-427-2588
Provider Enumeration Date:
01/26/2007