Provider First Line Business Practice Location Address:
1104 5TH 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:
25701-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-523-8671
Provider Business Practice Location Address Fax Number:
304-523-8674
Provider Enumeration Date:
08/05/2006