Provider First Line Business Practice Location Address:
1802 6TH 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:
25703-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-6674
Provider Business Practice Location Address Fax Number:
304-522-4647
Provider Enumeration Date:
06/30/2005