Provider First Line Business Practice Location Address:
2700 WASHBURN WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97603-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-0654
Provider Business Practice Location Address Fax Number:
541-273-2973
Provider Enumeration Date:
07/05/2005