Provider First Line Business Practice Location Address:
2828 FIRST AVENUE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-3692
Provider Business Practice Location Address Fax Number:
304-522-3693
Provider Enumeration Date:
11/08/2006