Provider First Line Business Practice Location Address:
2650 WASHBURN WY
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97603-4596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-6800
Provider Business Practice Location Address Fax Number:
541-882-6811
Provider Enumeration Date:
08/16/2006