Provider First Line Business Practice Location Address:
1249 15TH ST
Provider Second Line Business Practice Location Address:
SUITE 2000
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-1000
Provider Business Practice Location Address Fax Number:
304-691-1693
Provider Enumeration Date:
04/18/2006