Organization
LAKE NORMAN MUAY THAI LLC
Active
Other names
Lake Hickory Muay Thai LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER W SMITH (ACCOUNTANT)
(704) 502-7405
Entity
Organization
Contact information
Practice address
107 COMMONS DR STE I, MOORESVILLE, NC 28117-9262
(704) 657-1080
Mailing address
207 HICKORY HILL RD, MOORESVILLE, NC 28117-8215
(704) 657-1080
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/28/2025
Last updated
02/28/2025
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