Provider First Line Business Practice Location Address:
2303 CLAIRMONT DR
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:
97601-7149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-3427
Provider Business Practice Location Address Fax Number:
541-883-3469
Provider Enumeration Date:
11/30/2007