Provider First Line Business Practice Location Address: 
DEPARTMENT OF FAMILY MEDICINE
    Provider Second Line Business Practice Location Address: 
ROBERT C BYRD HEALTH SCIENCES CENTER
    Provider Business Practice Location Address City Name: 
MORGANTOWN
    Provider Business Practice Location Address State Name: 
WV
    Provider Business Practice Location Address Postal Code: 
26506-9152
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
304-598-6900
    Provider Business Practice Location Address Fax Number: 
304-598-6921
    Provider Enumeration Date: 
04/25/2008