Provider First Line Business Practice Location Address:
821 E KING 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:
28086-3186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-734-0304
Provider Business Practice Location Address Fax Number:
704-734-0309
Provider Enumeration Date:
03/12/2010