Provider First Line Business Practice Location Address:
608 W KING ST
Provider Second Line Business Practice Location Address:
SUITE C-D
Provider Business Practice Location Address City Name:
KINGS MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28086-3373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-734-1006
Provider Business Practice Location Address Fax Number:
704-734-1008
Provider Enumeration Date:
10/27/2010