Provider First Line Business Practice Location Address:
1336 AVALON ST
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:
97603-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-4745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006