| NPI | 1912466004 |
|---|---|
| Doing Business As | SUMMIT KETAMINE INNOVATIONS |
| Entity Type | Organization |
| Authorized Contact | SARAH LYNN COAKLEY President 719-641-7614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2019-03-18 |