Provider First Line Business Practice Location Address:
10850 US HIGHWAY 50
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:
67801-6538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-253-7924
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2023