Provider First Line Business Practice Location Address:
120 E 4TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTE CENTER
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-246-2976
Provider Business Practice Location Address Fax Number:
402-246-3208
Provider Enumeration Date:
01/16/2008