Provider First Line Business Practice Location Address:
120 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26330-9012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-7200
Provider Business Practice Location Address Fax Number:
304-624-0026
Provider Enumeration Date:
06/12/2006