Provider First Line Business Practice Location Address:
324 29TH ST
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:
25702-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-523-2790
Provider Business Practice Location Address Fax Number:
304-523-2780
Provider Enumeration Date:
09/29/2008