Provider First Line Business Practice Location Address:
46 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPENDALE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26753-9116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-697-0662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2025