Provider First Line Business Practice Location Address:
6001 DODGE ST
Provider Second Line Business Practice Location Address:
HEALTH AND KINESIOLOGY BUILDING
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68182-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-683-5311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2026