UPI (Provider ID): 10131
Change Report (if Any):

Short Name: NEIGHBOR-CHARDN

Long Name 1: NEIGHBORING
Long Name 2:

Address 1: 115 WILSON MILLS ROAD
Address 2: SUITE 4

City: CHARDON
Zip Code: 44024
County: GEAU

Contact: SPENCE KLINE
Title: EX DR
Phone: 4402867448
FAX: 4402864956

Vendor: 3458

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012