| NPI | 1689255127 |
|---|---|
| Doing Business As | GRACEWAY DIRECT |
| Entity Type | Organization |
| Authorized Contact | LORI WILLIAMS Owner 502-709-0590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2021-04-16 |