Provider First Line Business Practice Location Address:
2400 JOHNSTOWN RD
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:
25701-4738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-781-6712
Provider Business Practice Location Address Fax Number:
304-522-6382
Provider Enumeration Date:
03/23/2007