Individual
BRIANA LEE CRUSAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1 CITY CTR BAY CLUB, PORTLAND, ME 04101-6420
(207) 699-2622
Mailing address
1 CITY CTR BAY CLUB, PORTLAND, ME 04101-6420
(207) 699-2622
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT4047
ME
Other
Enumeration date
06/09/2009
Last updated
06/09/2009
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