Provider First Line Business Practice Location Address:
725 WASHBURN 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:
97603-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-1030
Provider Business Practice Location Address Fax Number:
541-884-2338
Provider Enumeration Date:
04/23/2009