Provider First Line Business Practice Location Address:
342 FOURTH AVENUE
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:
25701-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-9184
Provider Business Practice Location Address Fax Number:
304-525-9152
Provider Enumeration Date:
01/16/2007