UPI (Provider ID): 10037
Change Report (if Any):

Short Name: F & C SERV-PORT

Long Name 1: FAMILY AND COMMUNITY SERVICES
Long Name 2:

Address 1: 143 GOUGLER AVENUE
Address 2:

City: KENT
Zip Code: 44240
County: PORT

Contact: MARK FRISONE
Title: EXDIR
Phone: 3306774124
FAX: 3306781264

Vendor: 10037

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/29/2012

File Produced: 19MAY2012