Provider First Line Business Practice Location Address:
240 SAN JOSE RM 131
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:
67801-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-385-0206
Provider Business Practice Location Address Fax Number:
620-385-2245
Provider Enumeration Date:
10/18/2024