Provider First Line Business Practice Location Address:
302 VIRGINIA 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:
25701-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-6808
Provider Business Practice Location Address Fax Number:
304-697-6808
Provider Enumeration Date:
07/07/2005