Provider First Line Business Practice Location Address:
1021 MT DECHANTAL RD
Provider Second Line Business Practice Location Address:
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:
304-242-3043
Provider Business Practice Location Address Fax Number:
304-242-1422
Provider Enumeration Date:
11/01/2006