UPI (Provider ID): 10119
Change Report (if Any):

Short Name: FAM SER-LORA

Long Name 1: FAMILY SERVICE ASSOCIATION OF
Long Name 2: LORAIN COUNTY

Address 1: 1865 NORTH RIDGE ROAD
Address 2: SUITE E

City: LORAIN
Zip Code: 440553345
County: LORA

Contact: DAN BOLLINGER
Title:
Phone: 4402771800
FAX: 4402779317

Vendor: 10119

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012