Provider First Line Business Practice Location Address:
825 E. 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:
28086-3186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-650-6551
Provider Business Practice Location Address Fax Number:
704-512-4808
Provider Enumeration Date:
08/03/2011