Provider First Line Business Practice Location Address:
9709 MACCORKLE AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARMET
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25315-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-220-2424
Provider Business Practice Location Address Fax Number:
304-220-2427
Provider Enumeration Date:
11/28/2011