Provider First Line Business Practice Location Address:
342 5TH 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:
25701-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-1565
Provider Business Practice Location Address Fax Number:
304-525-3476
Provider Enumeration Date:
11/03/2006