Provider First Line Business Practice Location Address:
4118 5TH STREET 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:
25701-9547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-529-3784
Provider Business Practice Location Address Fax Number:
304-529-3785
Provider Enumeration Date:
03/11/2010