Provider First Line Business Practice Location Address:
623 DUNBAR COAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42261-8384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-662-4888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2017