Provider First Line Business Practice Location Address:
489 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301-2825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-622-2708
Provider Business Practice Location Address Fax Number:
304-623-9302
Provider Enumeration Date:
12/11/2007