Provider First Line Business Practice Location Address:
1 MEDICAL PARK
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:
26003-6379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-243-3124
Provider Business Practice Location Address Fax Number:
304-243-6343
Provider Enumeration Date:
05/22/2006