Provider First Line Business Practice Location Address:
3154 18TH AVE STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68601-3074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-942-9005
Provider Business Practice Location Address Fax Number:
402-913-3151
Provider Enumeration Date:
01/06/2026