Provider First Line Business Practice Location Address:
1616 13TH AVE
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-1404
Provider Business Practice Location Address Fax Number:
304-523-9763
Provider Enumeration Date:
08/18/2005