Provider First Line Business Practice Location Address:
1218 5TH 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:
25701-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-9959
Provider Business Practice Location Address Fax Number:
304-525-0277
Provider Enumeration Date:
10/09/2005