Provider First Line Business Practice Location Address:
607 E CLARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68786-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-539-2421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2025