Provider First Line Business Practice Location Address:
314 S. 14TH ST.
Provider Second Line Business Practice Location Address:
ORD PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
ORD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-381-7487
Provider Business Practice Location Address Fax Number:
308-381-2712
Provider Enumeration Date:
10/26/2010