Provider First Line Business Practice Location Address:
2860 THIRD AVE
Provider Second Line Business Practice Location Address:
SUITE 20
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:
304-525-2495
Provider Business Practice Location Address Fax Number:
304-525-0764
Provider Enumeration Date:
11/02/2006