Provider First Line Business Practice Location Address:
2900 EMERSON AVE
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:
26104-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-422-0172
Provider Business Practice Location Address Fax Number:
304-422-0174
Provider Enumeration Date:
06/02/2008