Provider First Line Business Practice Location Address:
706 MAIN ST STE 2A
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:
97601-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-851-7350
Provider Business Practice Location Address Fax Number:
541-851-7351
Provider Enumeration Date:
11/03/2006