Provider First Line Business Practice Location Address:
1900 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-887-8321
Provider Business Practice Location Address Fax Number:
541-887-8322
Provider Enumeration Date:
05/29/2014