Provider First Line Business Practice Location Address:
313 9TH 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:
25701-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-529-7871
Provider Business Practice Location Address Fax Number:
304-529-4957
Provider Enumeration Date:
12/01/2006