Provider First Line Business Practice Location Address:
1000 PINE 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:
97601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-1998
Provider Business Practice Location Address Fax Number:
541-850-5226
Provider Enumeration Date:
12/15/2006