Provider First Line Business Practice Location Address:
244 S WALNUT 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:
25705-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-8186
Provider Business Practice Location Address Fax Number:
304-733-9009
Provider Enumeration Date:
01/31/2010