Provider First Line Business Practice Location Address:
1206 CHAPLINE 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:
26003-3317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-232-0587
Provider Business Practice Location Address Fax Number:
304-232-1031
Provider Enumeration Date:
06/06/2007