Provider First Line Business Practice Location Address:
112 W ROSS BLVD STE C
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:
67801-7220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-371-6900
Provider Business Practice Location Address Fax Number:
620-371-6364
Provider Enumeration Date:
12/20/2022