Provider First Line Business Practice Location Address:
134 MEDICAL PLACE
Provider Second Line Business Practice Location Address:
AIRPORT INDUSTRIAL PARK, COMMERCE DRIVE
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-255-1080
Provider Business Practice Location Address Fax Number:
304-255-1082
Provider Enumeration Date:
08/21/2006