Provider First Line Business Practice Location Address:
2585 3RD 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:
25703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-781-5138
Provider Business Practice Location Address Fax Number:
304-697-2086
Provider Enumeration Date:
07/05/2006