Provider First Line Business Practice Location Address:
2300 CLAIRMONT 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:
97601-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-8134
Provider Business Practice Location Address Fax Number:
541-883-1510
Provider Enumeration Date:
10/06/2005