Provider First Line Business Practice Location Address:
7100 S 29TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516-6057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-476-0104
Provider Business Practice Location Address Fax Number:
402-438-2801
Provider Enumeration Date:
11/29/2012