Provider First Line Business Practice Location Address:
319 EAST A ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OGALLALA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-284-6519
Provider Business Practice Location Address Fax Number:
308-284-6513
Provider Enumeration Date:
11/21/2006