Provider First Line Business Practice Location Address:
2012 1ST AVE STE B
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:
67801-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-207-1321
Provider Business Practice Location Address Fax Number:
620-202-6757
Provider Enumeration Date:
03/21/2025