Provider First Line Business Practice Location Address:
211 E KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDICINE LODGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67104-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-886-3294
Provider Business Practice Location Address Fax Number:
620-202-4749
Provider Enumeration Date:
03/19/2026