Provider First Line Business Practice Location Address:
4540 US ROUTE 60
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:
25705-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
45-257-1113
Provider Business Practice Location Address Fax Number:
304-736-1589
Provider Enumeration Date:
05/22/2006