Provider First Line Business Practice Location Address:
2120 SOUTH 56TH ST
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-488-6100
Provider Business Practice Location Address Fax Number:
402-488-6210
Provider Enumeration Date:
12/05/2006