Provider First Line Business Practice Location Address:
9400 MILL BROOK RD
Provider Second Line Business Practice Location Address:
NORTHEAST YMCA
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-1271
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2013