Provider First Line Business Practice Location Address:
705 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-4437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-2234
Provider Business Practice Location Address Fax Number:
620-227-8284
Provider Enumeration Date:
04/24/2008