Provider First Line Business Practice Location Address:
101 E MAIN ST
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:
97601-3229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-205-6750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2023