Provider First Line Business Practice Location Address:
300 EAST 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COZAD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-784-2261
Provider Business Practice Location Address Fax Number:
308-784-2266
Provider Enumeration Date:
09/28/2006