Provider First Line Business Practice Location Address:
2261 S 6TH ST
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-3484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-6984
Provider Business Practice Location Address Fax Number:
541-884-7585
Provider Enumeration Date:
05/22/2015