Provider First Line Business Practice Location Address:
100 GUNSMOKE ST
Provider Second Line Business Practice Location Address:
BOX 7
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-4558
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2006