Provider First Line Business Practice Location Address:
1115 20TH ST STE 105
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:
25703-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-399-4141
Provider Business Practice Location Address Fax Number:
304-399-4145
Provider Enumeration Date:
04/14/2006