MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10200
Change Report (if Any):

Short Name: CONSUMERS HELP

Long Name 1: CONSUMERS HELPING CONSUMERS
Long Name 2:

Address 1: 706 PARK AVENUE
Address 2:

City: IRONTON
Zip Code: 45638
County: LAWR

Contact: HAROLD FLICK
Title: EXDIR
Phone: 7405326820
FAX: 7405328125

Vendor: 10200

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012