Provider First Line Business Practice Location Address:
1810 EAST 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-362-5538
Provider Business Practice Location Address Fax Number:
402-362-5680
Provider Enumeration Date:
10/01/2007