Provider First Line Business Practice Location Address:
38 WASHINGTON AVE
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:
25701-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-6991
Provider Business Practice Location Address Fax Number:
304-522-6924
Provider Enumeration Date:
10/22/2026