Provider First Line Business Practice Location Address:
1407-B
Provider Second Line Business Practice Location Address:
US RT 30 E
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-781-0202
Provider Business Practice Location Address Fax Number:
304-781-0203
Provider Enumeration Date:
10/02/2006