UPI (Provider ID): 10501
Change Report (if Any):

Short Name: WELLSPRING

Long Name 1: WELLSPRING
Long Name 2:

Address 1: 15 EAST PLEASANT STREET
Address 2:

City: SPRINGFIELD
Zip Code: 45506
County: CLAR

Contact: RICHELE SHEPARD
Title: EXDIR
Phone: 9373255564
FAX: 9373258727

Vendor: 10501

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/09/2011

File Produced: 19MAY2012