Provider First Line Business Practice Location Address:
703-1 EAST 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:
704-739-4519
Provider Business Practice Location Address Fax Number:
704-734-0936
Provider Enumeration Date:
07/05/2006