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1063016475
LISA DOUGHERTY
FAIRMONT, WV
NPI
1063016475
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
376J00000X Homemaker
Enumeration Date
2020-11-25
Last Update Date
2020-11-25
Business Address
LISA DOUGHERTY
503 MORGANTOWN AVE
FAIRMONT, WV 26554-4388
Phone number: 304-363-7375
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Mailing Address
LISA DOUGHERTY
217 HECKS RUN RD
FAIRMONT, WV 26554-2277
Phone number: 304-363-6280
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