Provider First Line Business Practice Location Address: 
2222 SOUTH 16TH STREET
    Provider Second Line Business Practice Location Address: 
SUITE 240
    Provider Business Practice Location Address City Name: 
LINCOLN
    Provider Business Practice Location Address State Name: 
NE
    Provider Business Practice Location Address Postal Code: 
68502-3764
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
402-323-7260
    Provider Business Practice Location Address Fax Number: 
402-323-7266
    Provider Enumeration Date: 
12/31/2007