Provider First Line Business Practice Location Address:
1421 ESPLANADE AVE STE 7
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:
97601-5956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-273-0340
Provider Business Practice Location Address Fax Number:
541-273-0340
Provider Enumeration Date:
08/20/2009