Provider First Line Business Practice Location Address:
2802 28TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68826-2707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-946-3015
Provider Business Practice Location Address Fax Number:
308-946-5914
Provider Enumeration Date:
03/27/2017