Provider First Line Business Practice Location Address:
2909 DAGGETT AVE
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:
97601-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-2947
Provider Business Practice Location Address Fax Number:
541-883-6104
Provider Enumeration Date:
07/19/2016