Provider First Line Business Practice Location Address:
2402 ADAMS 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:
25704-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-429-6716
Provider Business Practice Location Address Fax Number:
304-429-1924
Provider Enumeration Date:
12/20/2005