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| Type | Address | [sources] | |||
|---|---|---|---|---|---|
| Country | United States | [sources] | |||
| City | So. Charleston | [sources] | |||
| Full address | 4605 MacCorkle Ave SW, So. Charleston, WV 25309 | [sources] | |||
| Postal code | 25309 | [sources] | |||
| State | WV | [sources] | |||
| Street address | 4605 MacCorkle Ave SW | [sources] | |||
| Last change | Last processed | First seen | |||
Medicaid providers sanctioned in West Virginia's Medicaid program.
United States of America · MMIS
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