Provider First Line Business Practice Location Address:
3740 N 27TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68521-4162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-423-0396
Provider Business Practice Location Address Fax Number:
402-423-0397
Provider Enumeration Date:
08/28/2007