Provider First Line Business Practice Location Address:
5187 US ROUTE 60 EAST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-8800
Provider Business Practice Location Address Fax Number:
304-302-0221
Provider Enumeration Date:
03/23/2006