| NPI | 1417090358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE Director Of Operations 858-625-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: PA MD053809L) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-08-22 |