Provider First Line Business Practice Location Address:
120 W ROSS BLVD
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:
67801-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-1650
Provider Business Practice Location Address Fax Number:
620-227-2505
Provider Enumeration Date:
04/18/2006