Provider First Line Business Practice Location Address:
2000 N 14TH AVE
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:
67801-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-2299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2012