Provider First Line Business Practice Location Address:
1133 HUNTINGTON AVE APT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-690-1899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2025