Provider First Line Business Practice Location Address:
JGH - RAVENSWOOD CLINIC 504 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAVENWOOD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26164-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-373-1476
Provider Business Practice Location Address Fax Number:
304-373-1479
Provider Enumeration Date:
07/03/2019