Provider First Line Business Practice Location Address: 
2850 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: 
25702-1436
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
304-528-5000
    Provider Business Practice Location Address Fax Number: 
304-528-5080
    Provider Enumeration Date: 
01/30/2008