Provider First Line Business Practice Location Address:
303 EAST 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COZAD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-784-2231
Provider Business Practice Location Address Fax Number:
308-784-3449
Provider Enumeration Date:
10/16/2012