Provider First Line Business Practice Location Address:
113 E KIMBALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALLAWAY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68825-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-836-2219
Provider Business Practice Location Address Fax Number:
308-836-2625
Provider Enumeration Date:
11/30/2005