Provider First Line Business Practice Location Address:
5955 S 56TH ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516-3391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-423-7878
Provider Business Practice Location Address Fax Number:
402-423-0272
Provider Enumeration Date:
12/12/2006