Provider First Line Business Practice Location Address:
2115 CHAPINE STREET
Provider Second Line Business Practice Location Address:
SUITE 202
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:
304-234-8365
Provider Business Practice Location Address Fax Number:
304-234-8558
Provider Enumeration Date:
10/12/2006