Provider First Line Business Practice Location Address:
312 E PARKER ST
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:
28086-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-739-2077
Provider Business Practice Location Address Fax Number:
704-739-2995
Provider Enumeration Date:
11/01/2006