Provider First Line Business Practice Location Address:
1100 1/2 36TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26104-1637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-422-5611
Provider Business Practice Location Address Fax Number:
304-485-4519
Provider Enumeration Date:
09/07/2006