Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
LOUIS A. JOHNSON VA MEDICAL CENTER DRIVE
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-623-3461
Provider Business Practice Location Address Fax Number:
304-623-7650
Provider Enumeration Date:
03/23/2006