Provider First Line Business Practice Location Address:
2650 WASHBURN WAY
Provider Second Line Business Practice Location Address:
SUITE 180
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-1952
Provider Business Practice Location Address Fax Number:
541-884-6085
Provider Enumeration Date:
06/02/2011