Provider First Line Business Practice Location Address:
420 11TH ST
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:
25701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-697-1511
Provider Business Practice Location Address Fax Number:
304-697-2267
Provider Enumeration Date:
03/12/2008