Provider First Line Business Practice Location Address:
415 NORTH 66TH ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-464-6667
Provider Business Practice Location Address Fax Number:
402-464-6669
Provider Enumeration Date:
12/15/2006