Provider First Line Business Practice Location Address:
706 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-487-5520
Provider Business Practice Location Address Fax Number:
980-482-5540
Provider Enumeration Date:
05/28/2010