UPI (Provider ID): 10194
Change Report (if Any):

Short Name: MID-OHIO PSYC

Long Name 1: MID OHIO PSYCHOLOGICAL SERVICE
Long Name 2: INC

Address 1: 624 EAST MAIN STREET
Address 2:

City: LANCASTER
Zip Code: 43130
County: FAIR

Contact: BRADLEY HEDGES
Title: DIR
Phone: 7406870042
FAX: 7406876677

Vendor: 10194

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012