Provider First Line Business Practice Location Address:
1100 E WYATT EARP BLVD
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:
67801-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-8803
Provider Business Practice Location Address Fax Number:
620-227-8812
Provider Enumeration Date:
03/22/2006