Provider First Line Business Practice Location Address:
1931 WEST A 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:
308-532-4700
Provider Business Practice Location Address Fax Number:
308-534-0534
Provider Enumeration Date:
09/19/2005