| NPI | 1386800753 |
|---|---|
| Doing Business As | SOUTHLAKE CLINIC |
| Entity Type | Organization |
| Authorized Contact | MARIANNE LARSON Chief Operating Officer 425-251-5110 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2010-05-17 |