Provider First Line Business Practice Location Address:
5193 S ETNA 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:
97603-8536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-292-7688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2025