Provider First Line Business Practice Location Address:
156 KRUGER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-5160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-242-0866
Provider Business Practice Location Address Fax Number:
304-242-2252
Provider Enumeration Date:
11/27/2007