Provider First Line Business Practice Location Address:
23 N SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGALLALA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69153-2548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-284-2242
Provider Business Practice Location Address Fax Number:
308-284-8964
Provider Enumeration Date:
09/27/2006