UPI (Provider ID): 10193
Change Report (if Any):

Short Name: THE WOODLANDS

Long Name 1: THE WOODLANDS SERVING CENTRAL
Long Name 2: OHIO INC

Address 1: 195 UNION STREET SUITE B1
Address 2:

City: NEWARK
Zip Code: 43055
County: LICK

Contact: AARA CHAPMAN
Title:
Phone: 7403497066
FAX: 7403456028

Vendor: 10193

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012