Provider First Line Business Practice Location Address:
2680 UHRMANN RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-0639
Provider Business Practice Location Address Fax Number:
541-884-6901
Provider Enumeration Date:
12/19/2011