| NPI | 1720858301 |
|---|---|
| Former Legal Business Name | MT KULSHAN KETAMINE CLINIC |
| Entity Type | Organization |
| Authorized Contact | JOANNA STARRATT Clinical Director 509-405-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-01-05 |