UPI (Provider ID): 10999
Change Report (if Any):

Short Name: CNTR RSTR EMPOW

Long Name 1: CENTER OF RESTORATION AND
Long Name 2: EMPOWERMENT

Address 1: 1627 SELMA ROAD
Address 2:

City: SPRINGFIELD
Zip Code: 45505
County: CLAR

Contact: LINDA ROGAN-HONORE
Title:
Phone: 9373232814
FAX: 9373232988

Vendor: 10999

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012