UPI (Provider ID): 10110
Change Report (if Any):

Short Name: WOMENSAFE

Long Name 1: WOMENSAFE
Long Name 2:

Address 1: PO BOX 656
Address 2:

City: CHARDON
Zip Code: 44024
County: GEAU

Contact: DEBRA SUTTON
Title: DIR
Phone: 4402852222
FAX: .

Vendor: 10110

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/09/2011

File Produced: 19MAY2012