Provider First Line Business Practice Location Address:
7905 S 6TH STREET UNIT 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:
97603-7153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-883-4573
Provider Business Practice Location Address Fax Number:
541-883-4573
Provider Enumeration Date:
10/03/2007