Individual
JACOB CROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
270 WILSON ST, BREWER, ME 04412-1548
(207) 989-4401
Mailing address
270 WILSON ST, BREWER, ME 04412-1548
(207) 989-4401
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT539
ME
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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