Provider First Line Business Practice Location Address:
100 MILITARY AVE STE 116
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:
67801-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-3455
Provider Business Practice Location Address Fax Number:
620-225-1311
Provider Enumeration Date:
06/01/2007