Provider First Line Business Practice Location Address:
2401 CENTRAL AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-8193
Provider Business Practice Location Address Fax Number:
620-227-8006
Provider Enumeration Date:
11/02/2006