Provider First Line Business Practice Location Address:
210 1/2 WOODLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-6344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-4920
Provider Business Practice Location Address Fax Number:
620-225-4919
Provider Enumeration Date:
03/28/2018