Provider First Line Business Practice Location Address:
701 E COMANCHE LN STE B
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:
67801-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-9922
Provider Business Practice Location Address Fax Number:
620-225-1948
Provider Enumeration Date:
01/15/2008