Provider First Line Business Practice Location Address:
204 E FRONTVIEW ST
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:
67801-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-680-8427
Provider Business Practice Location Address Fax Number:
620-225-4286
Provider Enumeration Date:
08/13/2012