Provider First Line Business Practice Location Address: 
1600 MEDICAL CENTER DR
    Provider Second Line Business Practice Location Address: 
SUITE 3500
    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: 
340-691-1300
    Provider Business Practice Location Address Fax Number: 
304-691-1375
    Provider Enumeration Date: 
04/14/2015