Provider First Line Business Practice Location Address:
116 MEADOW LARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL CITY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-723-8821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2025