Provider First Line Business Practice Location Address:
1040 20TH ST
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:
25703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-3512
Provider Business Practice Location Address Fax Number:
304-522-6233
Provider Enumeration Date:
11/15/2006