Provider First Line Business Practice Location Address:
1010 SHELBY RD
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:
28086-2740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-739-9342
Provider Business Practice Location Address Fax Number:
704-739-0342
Provider Enumeration Date:
07/19/2006