Provider First Line Business Practice Location Address:
320 18TH ST.
Provider Second Line Business Practice Location Address:
GULLICKSON HALL SUITE G01
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-1643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2010