Provider First Line Business Practice Location Address:
705 1ST AVE STE C
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:
67801-4437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-271-1424
Provider Business Practice Location Address Fax Number:
877-272-8436
Provider Enumeration Date:
09/29/2025