Provider First Line Business Practice Location Address:
826 MAIN ST STE 1
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:
97601-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-887-8229
Provider Business Practice Location Address Fax Number:
541-887-8235
Provider Enumeration Date:
03/23/2012