Provider First Line Business Practice Location Address:
1601 W. 27TH ST.
Provider Second Line Business Practice Location Address:
WNCC HARMS BUILDING
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:
308-632-0411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2018