Provider First Line Business Practice Location Address:
4220 SHASTA WAY
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:
97603-4842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-1952
Provider Business Practice Location Address Fax Number:
541-884-6085
Provider Enumeration Date:
01/27/2016