UPI (Provider ID): 10169
Change Report (if Any):

Short Name: OAKHOUSE

Long Name 1: OAKHOUSE
Long Name 2:

Address 1: 333A BUCKEYE BLVD
Address 2:

City: PORT CLINTON
Zip Code: 43452
County: OTTA

Contact: ANN KERSTEN
Title:
Phone: 4197344417
FAX: 4197344922

Vendor: 10169

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 04/16/2012

File Produced: 19MAY2012