Provider First Line Business Practice Location Address:
1519 W HIGHWAY 34
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
SEWARD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68434-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-643-2918
Provider Business Practice Location Address Fax Number:
402-643-6956
Provider Enumeration Date:
08/16/2006