Provider First Line Business Practice Location Address:
501 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 208
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:
541-273-1166
Provider Business Practice Location Address Fax Number:
541-273-1822
Provider Enumeration Date:
10/12/2006