Provider First Line Business Practice Location Address:
117 W 4TH 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:
69101-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-248-7249
Provider Business Practice Location Address Fax Number:
308-888-6791
Provider Enumeration Date:
12/29/2018