Provider First Line Business Practice Location Address:
1509 AVENUE P
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-7032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-1442
Provider Business Practice Location Address Fax Number:
620-225-1709
Provider Enumeration Date:
06/10/2016