Provider First Line Business Practice Location Address:
213 1/2 G ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-946-2612
Provider Business Practice Location Address Fax Number:
308-946-2927
Provider Enumeration Date:
11/09/2006