Provider First Line Business Practice Location Address:
TWO WEST 42ND STREET L SUITE 1200
Provider Second Line Business Practice Location Address:
REGIONAL WEST MEDICAL PLAZA NORTH
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-630-1478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2006