Provider First Line Business Practice Location Address:
1775 WASHBURN WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97603-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-887-2507
Provider Business Practice Location Address Fax Number:
541-887-2508
Provider Enumeration Date:
04/30/2014