Provider First Line Business Practice Location Address:
2828 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-529-0483
Provider Business Practice Location Address Fax Number:
304-781-2687
Provider Enumeration Date:
05/31/2006