Provider First Line Business Practice Location Address:
1919 SOUTH 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-5247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-483-1054
Provider Business Practice Location Address Fax Number:
402-483-1056
Provider Enumeration Date:
12/14/2006