Provider First Line Business Practice Location Address:
905 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-5810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-850-5871
Provider Business Practice Location Address Fax Number:
541-850-9430
Provider Enumeration Date:
07/26/2005