Provider First Line Business Practice Location Address:
408 N PLATTE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68467-3575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-362-5846
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2015