Provider First Line Business Practice Location Address:
100 MILITARY AVE
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-338-2168
Provider Business Practice Location Address Fax Number:
620-225-1311
Provider Enumeration Date:
08/20/2006