UPI (Provider ID): 10126
Change Report (if Any):

Short Name: COURT CLINIC

Long Name 1: CENTRAL CLINIC COMMUNITY
Long Name 2: DIAGNOSTIC TREATMENT CENTER

Address 1: 909 SYCAMORE STREET
Address 2: SUITE 300

City: CINCINNATI
Zip Code: 45202
County: HAMI

Contact: FREDERICK SANDERS
Title: CFO
Phone: 5136519500
FAX: 5133521345

Vendor: 10126

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/19/2012

File Produced: 19MAY2012