Provider First Line Business Practice Location Address:
1401 S DEWEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-7622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-532-0220
Provider Business Practice Location Address Fax Number:
308-532-0500
Provider Enumeration Date:
08/12/2009