Provider First Line Business Practice Location Address:
COUNTRY DOCTOR COMMUNITY CLINIC
Provider Second Line Business Practice Location Address:
500 19TH AVENUE EAST
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-299-1600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2005