Provider First Line Business Practice Location Address:
8200 DODGE ST
Provider Second Line Business Practice Location Address:
2ND FLOOR SPC CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-559-6100
Provider Business Practice Location Address Fax Number:
402-552-7765
Provider Enumeration Date:
10/17/2006