Organization
SOUTHLAKE CLINIC INC PS
Active
Parent organization
SOUTHLAKE CLINIC INC PS
Other names
Southlake Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHLAKE CLINIC INC PS
Authorized official
MRS. MARIANNE LARSON (CHIEF OPERATING OFFICER)
(425) 251-5110
Entity
Organization
Contact information
Practice address
3915 TALBOT RD S, SUITE 300, RENTON, WA 98055-5738
(425) 251-5110
(425) 793-7458
Mailing address
PO BOX 59028, RENTON, WA 98058-2028
(425) 251-5110
(425) 793-7458
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
WA
Other
Enumeration date
08/05/2008
Last updated
05/17/2010
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