Provider First Line Business Practice Location Address:
2115 CHAPLINE ST
Provider Second Line Business Practice Location Address:
SUITE 101
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:
304-234-8046
Provider Business Practice Location Address Fax Number:
304-234-1668
Provider Enumeration Date:
07/30/2006