Provider First Line Business Practice Location Address:
1909 NORTH 14TH STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-338-8633
Provider Business Practice Location Address Fax Number:
620-338-8121
Provider Enumeration Date:
10/02/2006