Provider First Line Business Practice Location Address:
501 MAIN ST STE 310
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:
97601-6049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-887-8170
Provider Business Practice Location Address Fax Number:
541-887-8180
Provider Enumeration Date:
06/29/2006