Provider First Line Business Practice Location Address:
100 ROSS BLVD SUITE 2A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-3141
Provider Business Practice Location Address Fax Number:
620-227-8095
Provider Enumeration Date:
10/01/2008