Provider First Line Business Practice Location Address:
156-B KRUGER ST
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:
304-242-0199
Provider Business Practice Location Address Fax Number:
304-242-2252
Provider Enumeration Date:
11/29/2005