Provider First Line Business Practice Location Address:
14500 LARCH AVENUE
Provider Second Line Business Practice Location Address:
LA VIDA WEST CAL - SAFE
Provider Business Practice Location Address City Name:
LAWNDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90260-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-217-0616
Provider Business Practice Location Address Fax Number:
310-217-0545
Provider Enumeration Date:
02/08/2008