Provider First Line Business Practice Location Address:
5187 US ROUTE 60
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-697-2035
Provider Business Practice Location Address Fax Number:
304-781-2643
Provider Enumeration Date:
05/10/2007