| NPI | 1164563730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE Director Of Operations 858-625-2990 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: PA MD020996E) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-10-17 |