Provider First Line Business Practice Location Address:
202 W FAIRFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68933-1439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-762-3571
Provider Business Practice Location Address Fax Number:
402-762-3573
Provider Enumeration Date:
05/24/2005