Provider First Line Business Practice Location Address:
810 WEST KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGS MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28086-2748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-739-8946
Provider Business Practice Location Address Fax Number:
704-739-6443
Provider Enumeration Date:
04/27/2006