| NPI | 1518646041 |
|---|---|
| Doing Business As | UPSTATE KETAMINE AND WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | JASON BLASENAK Member 864-533-0029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2023-07-12 |