Provider First Line Business Practice Location Address:
3145 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19543-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-286-0920
Provider Business Practice Location Address Fax Number:
610-286-0960
Provider Enumeration Date:
05/26/2010