Provider First Line Business Practice Location Address:
310 WEST 38TH STREET
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:
308-635-1100
Provider Business Practice Location Address Fax Number:
308-635-1296
Provider Enumeration Date:
12/19/2006