Provider First Line Business Practice Location Address:
128 S 11TH 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:
97601-5806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-274-2770
Provider Business Practice Location Address Fax Number:
541-274-2779
Provider Enumeration Date:
10/14/2020