Provider First Line Business Practice Location Address:
5505 US ROUTE 60 EAST
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-948-6754
Provider Business Practice Location Address Fax Number:
304-948-6752
Provider Enumeration Date:
10/03/2013