Provider First Line Business Practice Location Address:
2218 SHALLOCK AVE
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:
97601-4290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-3818
Provider Business Practice Location Address Fax Number:
541-882-9800
Provider Enumeration Date:
01/19/2009