Provider First Line Business Practice Location Address:
4217 STURDIVANT AVE
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:
97603-7944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-357-6260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2025