| NPI | 1659563708 |
|---|---|
| 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 MD018088E) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2012-10-22 |