Provider First Line Business Practice Location Address:
4509 S 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE 209
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-8774
Provider Business Practice Location Address Fax Number:
541-884-6570
Provider Enumeration Date:
10/02/2006