Provider First Line Business Practice Location Address:
2074 S 6TH ST
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:
97601-3372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-880-2011
Provider Business Practice Location Address Fax Number:
541-885-5512
Provider Enumeration Date:
10/25/2006