Provider First Line Business Practice Location Address:
2600 CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-338-8286
Provider Business Practice Location Address Fax Number:
620-338-8287
Provider Enumeration Date:
05/27/2005