Provider First Line Business Practice Location Address:
2819 5TH AVE
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:
25702-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-9411
Provider Business Practice Location Address Fax Number:
304-522-4651
Provider Enumeration Date:
09/21/2006