Provider First Line Business Practice Location Address:
3425 DAKOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SIOUX CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-494-1136
Provider Business Practice Location Address Fax Number:
402-494-1239
Provider Enumeration Date:
04/23/2025