Provider First Line Business Practice Location Address:
2424 SHASTA WAY
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:
97601-4354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-2812
Provider Business Practice Location Address Fax Number:
541-882-5075
Provider Enumeration Date:
01/03/2008