Provider First Line Business Practice Location Address:
1430 SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68502-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-437-8986
Provider Business Practice Location Address Fax Number:
402-437-8928
Provider Enumeration Date:
02/02/2007