Provider First Line Business Practice Location Address:
1411 6TH 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:
25701-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-6132
Provider Business Practice Location Address Fax Number:
304-697-0471
Provider Enumeration Date:
12/13/2005