Provider First Line Business Practice Location Address:
143 N BROAD STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-851-0234
Provider Business Practice Location Address Fax Number:
541-884-6920
Provider Enumeration Date:
10/04/2006