Provider First Line Business Practice Location Address:
950 KLAMATH AVE
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:
97601-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-7095
Provider Business Practice Location Address Fax Number:
541-883-7095
Provider Enumeration Date:
10/03/2008