Provider First Line Business Practice Location Address:
5350 HOMEDALE RD
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:
97603-8437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-0447
Provider Business Practice Location Address Fax Number:
541-882-6961
Provider Enumeration Date:
08/03/2005