Provider First Line Business Practice Location Address:
30 MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-6391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-243-8630
Provider Business Practice Location Address Fax Number:
304-243-8575
Provider Enumeration Date:
07/20/2006