Provider First Line Business Practice Location Address:
608 W KING ST
Provider Second Line Business Practice Location Address:
PROF BUILDING 2
Provider Business Practice Location Address City Name:
KINGS MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28086-3358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-734-5129
Provider Business Practice Location Address Fax Number:
704-730-9536
Provider Enumeration Date:
07/04/2006