Provider First Line Business Practice Location Address:
106 W FRONTVIEW ST
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-4600
Provider Business Practice Location Address Fax Number:
620-225-4646
Provider Enumeration Date:
09/22/2006