Provider First Line Business Practice Location Address:
1420 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:
25704-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-7851
Provider Business Practice Location Address Fax Number:
304-525-1073
Provider Enumeration Date:
10/02/2006