Provider First Line Business Practice Location Address:
3647 HWY 39
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:
97603-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-5244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2011