Provider First Line Business Practice Location Address:
2301 MOUNTAIN VIEW BLVD
Provider Second Line Business Practice Location Address:
SUITE C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-3327
Provider Business Practice Location Address Fax Number:
541-883-3175
Provider Enumeration Date:
03/08/2006