Provider First Line Business Practice Location Address: 
987400 NEBRASKA MEDICAL CTR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
OMAHA
    Provider Business Practice Location Address State Name: 
NE
    Provider Business Practice Location Address Postal Code: 
68198-7400
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
402-559-6673
    Provider Business Practice Location Address Fax Number: 
402-559-8333
    Provider Enumeration Date: 
06/01/2011