Provider First Line Business Practice Location Address:
5187 ROUTE 60 EAST
Provider Second Line Business Practice Location Address:
10
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-3422
Provider Business Practice Location Address Fax Number:
304-736-2390
Provider Enumeration Date:
09/22/2006