Provider First Line Business Practice Location Address:
30 MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-242-4660
Provider Business Practice Location Address Fax Number:
304-242-6430
Provider Enumeration Date:
09/20/2006