Provider First Line Business Practice Location Address:
5170 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:
25705-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-528-4600
Provider Business Practice Location Address Fax Number:
304-697-0856
Provider Enumeration Date:
11/09/2007