Provider First Line Business Practice Location Address:
440 W MAIN ST
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:
26301-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-5679
Provider Business Practice Location Address Fax Number:
304-622-6888
Provider Enumeration Date:
10/31/2006