Provider First Line Business Practice Location Address:
965 S 27TH ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-477-3505
Provider Business Practice Location Address Fax Number:
402-573-6279
Provider Enumeration Date:
01/28/2010