Provider First Line Business Practice Location Address:
2520 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:
67801-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-7521
Provider Business Practice Location Address Fax Number:
620-227-3711
Provider Enumeration Date:
01/26/2006