Provider First Line Business Practice Location Address:
6001 DODGE STREET
Provider Second Line Business Practice Location Address:
102 HEALTH AND KINESIOLOGY BUILDING
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-559-0896
Provider Business Practice Location Address Fax Number:
402-554-2387
Provider Enumeration Date:
10/17/2022