Provider First Line Business Practice Location Address:
2800 6TH AVE STE 2
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:
67801-2478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-290-3936
Provider Business Practice Location Address Fax Number:
620-371-5135
Provider Enumeration Date:
07/10/2023