UPI (Provider ID): 10020
Change Report (if Any):

Short Name: FAM SER-DAYTON

Long Name 1: FAMILY SERVICE ASSOCIATION
Long Name 2:

Address 1: 2211 ARBOR BLVD
Address 2:

City: DAYTON
Zip Code: 45439
County: MONT

Contact: MIKE SCHNELDER
Title:
Phone: 9372229481
FAX: .

Vendor: 10020

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012