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:
25705-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-7616
Provider Business Practice Location Address Fax Number:
317-259-4234
Provider Enumeration Date:
08/28/2006