Provider First Line Business Practice Location Address:
1900 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-2929
Provider Business Practice Location Address Fax Number:
541-850-0930
Provider Enumeration Date:
03/13/2007