Provider First Line Business Practice Location Address:
632 13TH ST.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-529-6636
Provider Business Practice Location Address Fax Number:
304-529-6618
Provider Enumeration Date:
11/12/2008