Provider First Line Business Practice Location Address:
2900 DAGGETT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-1317
Provider Business Practice Location Address Fax Number:
541-274-4395
Provider Enumeration Date:
06/16/2011