Provider First Line Business Practice Location Address:
40 W MAIN ST
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:
26501-4567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-282-1627
Provider Business Practice Location Address Fax Number:
304-243-5880
Provider Enumeration Date:
12/21/2011