Provider First Line Business Practice Location Address:
2300 N 14TH AVE STE 100A
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:
67801-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-7829
Provider Business Practice Location Address Fax Number:
620-225-4827
Provider Enumeration Date:
02/22/2008