Provider First Line Business Practice Location Address:
1225 WASHINGTON 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:
25704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-0395
Provider Business Practice Location Address Fax Number:
304-523-0903
Provider Enumeration Date:
08/12/2006