Provider First Line Business Practice Location Address:
310 S 5TH ST
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:
97601-6108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-2795
Provider Business Practice Location Address Fax Number:
541-850-0239
Provider Enumeration Date:
07/03/2006