Provider First Line Business Practice Location Address:
1166 ADAMS AVE
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:
25704-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-1787
Provider Business Practice Location Address Fax Number:
304-522-4571
Provider Enumeration Date:
05/24/2005