| NPI | 1720866916 |
|---|---|
| Doing Business As | KETAMINE CENTER OF CONNECTICUT |
| Entity Type | Organization |
| Authorized Contact | AL GENE EJUSA ANG Office Manager 860-552-7592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-11-30 |