Provider First Line Business Practice Location Address:
1761 AUSTIN 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:
97603-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-9039
Provider Business Practice Location Address Fax Number:
541-851-9270
Provider Enumeration Date:
07/08/2025