Provider First Line Business Practice Location Address:
227 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNDSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26041-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-8551
Provider Business Practice Location Address Fax Number:
304-845-7678
Provider Enumeration Date:
09/15/2005