Provider First Line Business Practice Location Address:
PPHD 18 W. 15TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-633-2866
Provider Business Practice Location Address Fax Number:
308-487-3682
Provider Enumeration Date:
09/16/2021