Provider First Line Business Practice Location Address:
1665 DAYTON ST
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:
97603-3805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-4428
Provider Business Practice Location Address Fax Number:
541-850-3847
Provider Enumeration Date:
09/22/2010