Provider First Line Business Practice Location Address:
520 EAST 10TH STREET
Provider Second Line Business Practice Location Address:
BROADSTONE MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-463-5684
Provider Business Practice Location Address Fax Number:
402-463-5686
Provider Enumeration Date:
09/29/2006