Provider First Line Business Practice Location Address:
15237 COAL HERITAGE ROAD/US-52 NORTH
Provider Second Line Business Practice Location Address:
HONEYCAMP/247
Provider Business Practice Location Address City Name:
RODERFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-436-8323
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2009