Provider First Line Business Practice Location Address:
5747 MEMORIAL GYM
Provider Second Line Business Practice Location Address:
KESSOCK SPORTSMEDICINE CENTER
Provider Business Practice Location Address City Name:
ORONO
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04469-5747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-581-1071
Provider Business Practice Location Address Fax Number:
207-581-4474
Provider Enumeration Date:
06/19/2006