Provider First Line Business Practice Location Address:
3168 SUMNER AVE
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:
25705-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-412-4246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2008