Provider First Line Business Practice Location Address:
2240 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25703-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-4445
Provider Business Practice Location Address Fax Number:
304-529-7449
Provider Enumeration Date:
06/22/2010