UPI (Provider ID): 10698
Change Report (if Any):

Short Name: NORTHLAND INTRV

Long Name 1: NORTHLAND INTERVENTION CENTER
Long Name 2: INC

Address 1: 37 EAST MAIN STREET
Address 2:

City: AMELIA
Zip Code: 451021747
County: CLER

Contact: LINDA DUNLAP
Title: DIR
Phone: 5137539964
FAX: 5137539968

Vendor: 10698

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012