Provider First Line Business Practice Location Address:
6510 S 6TH ST PMB 73
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:
97603-7112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-545-1812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007