Provider First Line Business Practice Location Address: 
7710 MERCY ROAD, SUITE 202
    Provider Second Line Business Practice Location Address: 
CU DEPARTMENT OF PSYCHIATRY
    Provider Business Practice Location Address City Name: 
OMAHA
    Provider Business Practice Location Address State Name: 
NE
    Provider Business Practice Location Address Postal Code: 
68124-2353
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
402-280-4195
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/10/2023