Provider First Line Business Practice Location Address:
1102 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-1559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-529-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006