Provider First Line Business Practice Location Address:
924 S KIMBALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND ISLAND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68801-7920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-383-4402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2026