Provider First Line Business Practice Location Address:
827 EAST KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGS MTN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-739-5610
Provider Business Practice Location Address Fax Number:
704-739-4556
Provider Enumeration Date:
12/06/2006