Provider First Line Business Practice Location Address:
2586 CLOVER ST
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:
97601-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-9555
Provider Business Practice Location Address Fax Number:
541-882-7423
Provider Enumeration Date:
07/11/2007