Provider First Line Business Practice Location Address:
612 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:
25701-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-4202
Provider Business Practice Location Address Fax Number:
304-525-4231
Provider Enumeration Date:
04/18/2007