Provider First Line Business Practice Location Address:
37456 COAL RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITESVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25209-9077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-1323
Provider Business Practice Location Address Fax Number:
304-854-1031
Provider Enumeration Date:
12/11/2006