Provider First Line Business Practice Location Address:
322 12TH 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:
25701-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-781-6960
Provider Business Practice Location Address Fax Number:
304-781-3510
Provider Enumeration Date:
11/25/2020