UPI (Provider ID): 10196
Change Report (if Any):

Short Name: LIGHTHOUSE-FAIR

Long Name 1: THE LIGHTHOUSE INC
Long Name 2:

Address 1: PO BOX 215
Address 2:

City: LANCASTER
Zip Code: 43130
County: FAIR

Contact: SUZANNE PELLETIER-DA
Title: EX DR
Phone: 7406874423
FAX: 7406871048

Vendor: 10196

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/24/2012

File Produced: 19MAY2012