Provider First Line Business Practice Location Address:
905 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 615
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-5810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-810-3654
Provider Business Practice Location Address Fax Number:
541-273-6357
Provider Enumeration Date:
09/19/2005