Provider First Line Business Practice Location Address:
3448 US ROUTE 60
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:
25705-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-1550
Provider Business Practice Location Address Fax Number:
304-522-0704
Provider Enumeration Date:
12/27/2005