UPI (Provider ID): 10201
Change Report (if Any):

Short Name: FAIRFIELD MH GP

Long Name 1: FAIRFIELD MH CONSUMER GROUP
Long Name 2:

Address 1: 1410 EAST MAIN STREET
Address 2: PO BOX 1459

City: LANCASTER
Zip Code: 43130
County: FAIR

Contact: JANET GALLIGAN
Title: EX DR
Phone: 7406540477
FAX: 7406540477

Vendor: 10201

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012