Provider First Line Business Practice Location Address:
5505 US ROUTE 60
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-730-4153
Provider Business Practice Location Address Fax Number:
304-736-9997
Provider Enumeration Date:
09/30/2013