Provider First Line Business Practice Location Address:
WVU & ROUTE 220 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER TRACT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26866-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-5033
Provider Business Practice Location Address Fax Number:
304-293-6963
Provider Enumeration Date:
05/16/2007