Provider First Line Business Practice Location Address:
416 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-5619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-485-7485
Provider Business Practice Location Address Fax Number:
304-491-6172
Provider Enumeration Date:
04/18/2006