Provider First Line Business Practice Location Address:
900 INDEPENDENCE RD.
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:
25823-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-469-2905
Provider Business Practice Location Address Fax Number:
304-683-6903
Provider Enumeration Date:
10/30/2008