Organization
SOUTHLAKE CLINIC INC PS
Active
Parent organization
SOUTHLAKE CLINIC INC PS
Other names
Valley Internal Medicine Inc PS
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHLAKE CLINIC INC PS
Authorized official
MARIANNE LARSON (CHIEF OPERATIONS OFFICER)
(425) 251-5110
Entity
Organization
Contact information
Practice address
3915 TALBOT ROAD SOUTH, SUITE 300, RENTON, WA 98055
(425) 251-5110
(425) 226-9085
Mailing address
PO BOX 59028, RENTON, WA 98058-2028
(425) 251-5110
(425) 793-4707
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
600052154
WA
Other
Enumeration date
01/10/2007
Last updated
03/03/2010
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