Provider First Line Business Practice Location Address:
601 W LEOTA 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-696-8577
Provider Business Practice Location Address Fax Number:
308-696-8579
Provider Enumeration Date:
02/12/2007