Provider First Line Business Practice Location Address:
3135 16TH STREET
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:
25701-5247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
681-404-6869
Provider Business Practice Location Address Fax Number:
681-404-6871
Provider Enumeration Date:
11/08/2006