| NPI | 1083276992 |
|---|---|
| Doing Business As | KETAMINE INTEGRATIVE MEDICINE |
| Entity Type | Organization |
| Authorized Contact | ANNETTE ALTAMIRANO LUSKO Medical Director 480-571-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2019-07-01 |