Provider First Line Business Practice Location Address:
2340 S 6TH 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:
97601-4340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-204-4493
Provider Business Practice Location Address Fax Number:
541-291-9825
Provider Enumeration Date:
08/27/2014