Provider First Line Business Practice Location Address:
1323 ELM AVE
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-6213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-683-6621
Provider Business Practice Location Address Fax Number:
541-850-8461
Provider Enumeration Date:
07/27/2006