Provider First Line Business Practice Location Address:
NEBRASKA STATE PENITIENTIARY
Provider Second Line Business Practice Location Address:
4201 S 14TH ST
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-479-3218
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007