Provider First Line Business Practice Location Address:
1 MATE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATEWAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25678-0537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-426-4161
Provider Business Practice Location Address Fax Number:
304-426-4162
Provider Enumeration Date:
09/24/2014