Provider First Line Business Practice Location Address:
2115 CHAPLINE ST
Provider Second Line Business Practice Location Address:
SU 208
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-3859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-232-6956
Provider Business Practice Location Address Fax Number:
304-234-8824
Provider Enumeration Date:
10/02/2006