Provider First Line Business Practice Location Address:
501 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-6049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-892-4808
Provider Business Practice Location Address Fax Number:
866-308-0718
Provider Enumeration Date:
02/08/2007