Provider First Line Business Practice Location Address:
2222 S 16TH ST MEDICAL TOWER B
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-488-3002
Provider Business Practice Location Address Fax Number:
402-483-8787
Provider Enumeration Date:
12/22/2005