Provider First Line Business Practice Location Address:
2405 CENTRAL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-2471
Provider Business Practice Location Address Fax Number:
620-227-2334
Provider Enumeration Date:
05/04/2007