Provider First Line Business Practice Location Address:
2700 WASHBURN 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:
97603-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-5464
Provider Business Practice Location Address Fax Number:
541-850-8847
Provider Enumeration Date:
08/22/2006