Provider First Line Business Practice Location Address:
144 W MOUNTAIN ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
KINGS MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28086-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-607-3324
Provider Business Practice Location Address Fax Number:
704-675-5814
Provider Enumeration Date:
05/12/2009