| NPI | 1962543439 |
|---|---|
| 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 MD030965E) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2010-08-02 |