UPI (Provider ID): 10299
Change Report (if Any):

Short Name: SHERIFF-VAN WER

Long Name 1: DANNY LACEFIELD
Long Name 2:

Address 1: 6045 GERMAN CHURCH ROAD
Address 2:

City: VAN WERT
Zip Code: 45891
County: VANW

Contact: STAN OWENS
Title: SHERF
Phone: 4192383866
FAX: .

Vendor: 10299

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012