| NPI | 1194146555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE VP Of Operations 858-964-1506 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: AZ 16317) |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2014-01-02 |