Provider First Line Business Practice Location Address:
705 FIRST AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-2234
Provider Business Practice Location Address Fax Number:
620-227-8084
Provider Enumeration Date:
11/08/2006