Provider First Line Business Practice Location Address:
2601 E 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:
620-225-5262
Provider Business Practice Location Address Fax Number:
620-275-8924
Provider Enumeration Date:
02/08/2018