UPI (Provider ID): 10167
Change Report (if Any):

Short Name: D V EDNA BROOKS

Long Name 1: THE EDNA BROOKS FOUNDATION INC
Long Name 2:

Address 1: PO BOX 1158
Address 2:

City: ATHENS
Zip Code: 457011158
County: ATHE

Contact: MARYANN STALDER
Title:
Phone: 7405937125
FAX: 7405947122

Vendor: 10167

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/06/2012

File Produced: 19MAY2012