Provider First Line Business Practice Location Address:
112 W ROSS BLVD STE C
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:
67801-7220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-371-3939
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2011