Provider First Line Business Practice Location Address:
211 W LEOTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-532-0310
Provider Business Practice Location Address Fax Number:
308-532-2781
Provider Enumeration Date:
09/28/2006