Provider First Line Business Practice Location Address:
77 HOSPITAL DR STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-792-1132
Provider Business Practice Location Address Fax Number:
304-792-1133
Provider Enumeration Date:
06/29/2006