Provider First Line Business Practice Location Address:
2300 N 14TH AVE STE 200
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:
67801-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-371-5197
Provider Business Practice Location Address Fax Number:
620-371-5149
Provider Enumeration Date:
06/06/2023