Provider First Line Business Practice Location Address:
1122 MARKET ST
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:
26101-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-485-5531
Provider Business Practice Location Address Fax Number:
304-485-9596
Provider Enumeration Date:
04/25/2007