Provider First Line Business Practice Location Address:
2650 WASHBURN WAY
Provider Second Line Business Practice Location Address:
SUITE 240
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-363-0201
Provider Business Practice Location Address Fax Number:
810-982-9906
Provider Enumeration Date:
12/19/2006