Provider First Line Business Practice Location Address:
3120 COLLINS FERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-599-2733
Provider Business Practice Location Address Fax Number:
304-599-4428
Provider Enumeration Date:
12/15/2005