Provider First Line Business Practice Location Address:
1535 TAMERA DR
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:
97603-4179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-2911
Provider Business Practice Location Address Fax Number:
541-884-7987
Provider Enumeration Date:
08/31/2006