Provider First Line Business Practice Location Address:
5699 US ROUTE 60
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:
25705-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-6126
Provider Business Practice Location Address Fax Number:
304-736-1531
Provider Enumeration Date:
11/09/2006