Provider First Line Business Practice Location Address:
624 SOUTH TER
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:
25705-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-412-4246
Provider Business Practice Location Address Fax Number:
304-523-0044
Provider Enumeration Date:
08/02/2008