Provider First Line Business Practice Location Address:
1306 W SPRUCE 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:
67801-4028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-253-3478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2018