Provider First Line Business Practice Location Address:
3949 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:
97603-4746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-552-6290
Provider Business Practice Location Address Fax Number:
541-880-0560
Provider Enumeration Date:
07/26/2005