Provider First Line Business Practice Location Address: 
THE NEBRASKA MEDICAL CENTER PICU
    Provider Second Line Business Practice Location Address: 
982145 NEBRASKA MEDICAL CENTER
    Provider Business Practice Location Address City Name: 
OMAHA
    Provider Business Practice Location Address State Name: 
NE
    Provider Business Practice Location Address Postal Code: 
68198-2145
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
402-559-5257
    Provider Business Practice Location Address Fax Number: 
402-559-2025
    Provider Enumeration Date: 
07/28/2011