Provider First Line Business Practice Location Address:
10 MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 206
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:
304-243-6534
Provider Business Practice Location Address Fax Number:
304-243-8575
Provider Enumeration Date:
07/17/2007