Provider First Line Business Practice Location Address:
2300 N 14TH AVE STE 104
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:
67801-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-8865
Provider Business Practice Location Address Fax Number:
620-225-8866
Provider Enumeration Date:
11/10/2005