Provider First Line Business Practice Location Address:
5230 S 6TH 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:
97603-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-273-1560
Provider Business Practice Location Address Fax Number:
541-850-0637
Provider Enumeration Date:
09/10/2009