Provider First Line Business Practice Location Address:
2555 MAIN STREET
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:
97603-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-516-4087
Provider Business Practice Location Address Fax Number:
540-504-1195
Provider Enumeration Date:
02/21/2013