Provider First Line Business Practice Location Address:
2800 FOOTHILLS BLVD
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:
97603-3768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-7409
Provider Business Practice Location Address Fax Number:
541-850-8672
Provider Enumeration Date:
01/02/2007