Provider First Line Business Practice Location Address:
2201 CENTRAL AVE STE A
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:
67801-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-798-4821
Provider Business Practice Location Address Fax Number:
785-798-4823
Provider Enumeration Date:
05/19/2014