Provider First Line Business Practice Location Address:
1618 N 28TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68503-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
531-280-8193
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2025