UPI (Provider ID): 10057
Change Report (if Any):

Short Name: CHILD DIAG CNTR

Long Name 1: CENTRAL CLINIC
Long Name 2: CDC MENTAL HEALTH SERVICES

Address 1: 2100 PLEASANT AVENUE
Address 2:

City: HAMILITON
Zip Code: 45011
County: BUTL

Contact: BARB PHILLIPS
Title: OFF
Phone: 5138681562
FAX: 5138681415

Vendor: 10057

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/24/2012

File Produced: 19MAY2012