Provider First Line Business Practice Location Address:
2628 FIFTH AVENUE
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:
25702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-836-7377
Provider Business Practice Location Address Fax Number:
606-836-2189
Provider Enumeration Date:
08/20/2006