Provider First Line Business Practice Location Address:
LINCOLN REGIONAL CENTER BUILDING 3
Provider Second Line Business Practice Location Address:
W. PROSPECTOR PLACE AND FOLSOM ST.
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68509-4949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-479-5202
Provider Business Practice Location Address Fax Number:
402-479-5238
Provider Enumeration Date:
10/05/2010