Provider First Line Business Practice Location Address:
2600 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-6220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-9008
Provider Business Practice Location Address Fax Number:
620-227-2483
Provider Enumeration Date:
08/08/2006