Provider First Line Business Practice Location Address:
2312 S 6TH ST STE B
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:
541-236-2123
Provider Business Practice Location Address Fax Number:
888-706-1637
Provider Enumeration Date:
07/15/2020