Provider First Line Business Practice Location Address:
50 WASHINGTON AVE
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:
26003-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-695-3822
Provider Business Practice Location Address Fax Number:
740-695-3822
Provider Enumeration Date:
02/17/2007