Provider First Line Business Practice Location Address:
5925 N 28TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68504-9820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-441-4160
Provider Business Practice Location Address Fax Number:
402-441-4164
Provider Enumeration Date:
11/26/2012