Provider First Line Business Practice Location Address:
1903 AUSTIN ST STE B
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:
97603-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-850-8577
Provider Business Practice Location Address Fax Number:
541-850-5821
Provider Enumeration Date:
02/19/2007