Provider First Line Business Practice Location Address:
2501 3RD 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:
25703-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-0252
Provider Business Practice Location Address Fax Number:
304-522-1020
Provider Enumeration Date:
05/04/2007