Provider First Line Business Practice Location Address:
2421 WASHBURN WAY STE K
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:
97603-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-885-1675
Provider Business Practice Location Address Fax Number:
541-885-1817
Provider Enumeration Date:
06/25/2018