Provider First Line Business Practice Location Address:
1929 WEST A 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-221-6850
Provider Business Practice Location Address Fax Number:
308-221-6852
Provider Enumeration Date:
08/10/2006