Provider First Line Business Practice Location Address:
2828 FIRST AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702-1241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-526-1227
Provider Business Practice Location Address Fax Number:
304-526-1526
Provider Enumeration Date:
04/13/2007