Provider First Line Business Practice Location Address:
815 LOGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRIBNER
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68057-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-664-2527
Provider Business Practice Location Address Fax Number:
402-664-3670
Provider Enumeration Date:
11/02/2005