Provider First Line Business Practice Location Address:
110 WEST KING STREET
Provider Second Line Business Practice Location Address:
STE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-739-3373
Provider Business Practice Location Address Fax Number:
704-739-3918
Provider Enumeration Date:
09/29/2006