Provider First Line Business Practice Location Address:
600 W 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69033-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-414-1968
Provider Business Practice Location Address Fax Number:
308-534-3404
Provider Enumeration Date:
03/22/2007