Provider First Line Business Practice Location Address:
241 SALMON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-482-2181
Provider Business Practice Location Address Fax Number:
707-482-3655
Provider Enumeration Date:
07/12/2005