Provider First Line Business Practice Location Address:
WEST PROSPECTOR PLACE & SOUTH FOLSOM STREETS
Provider Second Line Business Practice Location Address:
DHHS
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-479-5388
Provider Business Practice Location Address Fax Number:
402-479-5591
Provider Enumeration Date:
02/15/2007