Provider First Line Business Practice Location Address:
501 MAIN ST, SUITE 207
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:
541-223-9417
Provider Business Practice Location Address Fax Number:
541-882-2583
Provider Enumeration Date:
07/20/2005