Provider First Line Business Practice Location Address:
3246 US ROUTE 60
Provider Second Line Business Practice Location Address:
SUITE 26
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-8910
Provider Business Practice Location Address Fax Number:
304-691-1860
Provider Enumeration Date:
10/17/2005