Provider First Line Business Practice Location Address:
513 N GRANT ST
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68850-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-324-0222
Provider Business Practice Location Address Fax Number:
308-324-0225
Provider Enumeration Date:
01/03/2008