Provider First Line Business Practice Location Address:
916 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-529-1388
Provider Business Practice Location Address Fax Number:
304-781-9200
Provider Enumeration Date:
10/24/2008