| NPI | 1669513420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE Dir. Of Operations 858-625-2990 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: PA OS004121L) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2012-10-17 |