03D2141220 CLIA NUMBER - KETAMINE INFUSION CENTERS LLC

Laboratory Demographics

CLIA Number: 03D2141220

Facility Name: KETAMINE INFUSION CENTERS LLC

Facility Address:
3724 N 3RD ST, #201
PHOENIX, AZ
ZIP 85012
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Facility Phone Number: (602) 344-9850

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1740790823

Taxonomy: 261QI0500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2141220
LAB Type	PHYSICIAN OFFICE
Facility Name	KETAMINE INFUSION CENTERS LLC
Street	3724 N 3RD ST, #201
City	PHOENIX
State	AZ
ZIP	85012
Phone	(602) 344-9850

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This page was last updated on: 5/11/2023