Provider First Line Business Practice Location Address:
1125 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:
25703-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-529-2739
Provider Business Practice Location Address Fax Number:
304-529-0068
Provider Enumeration Date:
01/25/2007