Provider First Line Business Practice Location Address:
7312 COAL CITY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RHODELL
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25915-0158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-683-4318
Provider Business Practice Location Address Fax Number:
304-683-4791
Provider Enumeration Date:
10/17/2006