Provider First Line Business Practice Location Address:
5187 US ROUTE 60 STE 5
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:
25705-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-733-5990
Provider Business Practice Location Address Fax Number:
304-733-5991
Provider Enumeration Date:
02/04/2011