Provider First Line Business Practice Location Address:
4201 SOUTH 14TH ST
Provider Second Line Business Practice Location Address:
NEBR. STATE PENITENTIARY
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-479-3291
Provider Business Practice Location Address Fax Number:
402-479-3325
Provider Enumeration Date:
03/19/2007