UPI (Provider ID): 10101
Change Report (if Any):

Short Name: DIAG AND EVAL

Long Name 1: D AND E COUNSELING CENTER INC
Long Name 2:

Address 1: 142 JAVIT COURT
Address 2:

City: YOUNGSTOWN
Zip Code: 44515
County: MAHO

Contact: PAUL CHANEY
Title: MIS
Phone: 3307932487
FAX: 3307934559

Vendor: 10101

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/12/2011

File Produced: 19MAY2012