Provider First Line Business Practice Location Address:
3203 VANDENBERG RD
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:
97603-3778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-880-5500
Provider Business Practice Location Address Fax Number:
541-880-5513
Provider Enumeration Date:
10/14/2014