Provider First Line Business Practice Location Address:
305 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMPHREY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68642-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-923-0905
Provider Business Practice Location Address Fax Number:
402-923-9023
Provider Enumeration Date:
05/16/2006