Provider First Line Business Practice Location Address:
5561 SOUTH 48TH STREET
Provider Second Line Business Practice Location Address:
STE. 215-D
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-540-0302
Provider Business Practice Location Address Fax Number:
402-581-6171
Provider Enumeration Date:
07/13/2009