Provider First Line Business Practice Location Address:
2601 CENTRAL AVE STE 22
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:
67801-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-0113
Provider Business Practice Location Address Fax Number:
620-225-0102
Provider Enumeration Date:
09/15/2015