Provider First Line Business Practice Location Address:
3001 DAGGETT AVE STE 101
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:
97601-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-274-3278
Provider Business Practice Location Address Fax Number:
541-274-3275
Provider Enumeration Date:
12/21/2006