Provider First Line Business Practice Location Address:
ROUTES 28 55
Provider Second Line Business Practice Location Address:
GRANT MEMORIAL HOSPITAL DRIVE
Provider Business Practice Location Address City Name:
PETERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26847-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-257-1026
Provider Business Practice Location Address Fax Number:
304-257-2537
Provider Enumeration Date:
01/29/2007