Provider First Line Business Practice Location Address:
1513 W WYATT EARP BLVD
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:
67801-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-682-8304
Provider Business Practice Location Address Fax Number:
620-682-8305
Provider Enumeration Date:
02/01/2022