Provider First Line Business Practice Location Address:
619 N 2ND AVE
Provider Second Line Business Practice Location Address:
#508
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-5984
Provider Business Practice Location Address Fax Number:
620-225-0739
Provider Enumeration Date:
10/04/2006