Provider First Line Business Practice Location Address: 
991 W HUDSON BLVD
    Provider Second Line Business Practice Location Address: 
GASTON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES
    Provider Business Practice Location Address City Name: 
GASTONIA
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28052-6430
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
704-853-5260
    Provider Business Practice Location Address Fax Number: 
704-853-5252
    Provider Enumeration Date: 
03/21/2006