Provider First Line Business Practice Location Address:
2530 SHASTA WAY
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:
97601-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-4550
Provider Business Practice Location Address Fax Number:
541-884-4676
Provider Enumeration Date:
02/19/2008