Provider First Line Business Practice Location Address:
10008 COAL RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SETH
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25181-0611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-837-3399
Provider Business Practice Location Address Fax Number:
304-854-1031
Provider Enumeration Date:
01/15/2020