Provider First Line Business Practice Location Address:
422 KINETIC PARK DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-523-5100
Provider Business Practice Location Address Fax Number:
304-523-1750
Provider Enumeration Date:
03/15/2006