Provider First Line Business Practice Location Address:
120 E 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-441-7940
Provider Business Practice Location Address Fax Number:
402-441-8491
Provider Enumeration Date:
05/21/2026