Provider First Line Business Practice Location Address:
2115 CHAPLINE STREET
Provider Second Line Business Practice Location Address:
STE 201
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:
304-234-1610
Provider Business Practice Location Address Fax Number:
304-234-1739
Provider Enumeration Date:
09/27/2006