Provider First Line Business Practice Location Address:
1401 EAST H STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MCCOOK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69001-3432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-345-7878
Provider Business Practice Location Address Fax Number:
308-345-7879
Provider Enumeration Date:
02/24/2006