Individual
SUSAN ANN RAQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 CARGO CT, LOUISVILLE, KY 40299-1938
(800) 805-6989
Mailing address
1700 CARGO CT, LOUISVILLE, KY 40299-1938
(800) 805-6989
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
1082389
KY
Other
Enumeration date
02/15/2022
Last updated
02/15/2022
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