Provider First Line Business Practice Location Address:
2311 OHIO AVE
Provider Second Line Business Practice Location Address:
MEMORIAL BRIDGE PLAZA UNIT-B
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-438-3007
Provider Business Practice Location Address Fax Number:
304-428-9527
Provider Enumeration Date:
09/20/2006