Provider First Line Business Practice Location Address:
1026 20TH 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:
25703-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-523-4141
Provider Business Practice Location Address Fax Number:
304-523-0846
Provider Enumeration Date:
11/29/2006