UPI (Provider ID): 11137
Change Report (if Any):

Short Name: EAGLE EYE FDC

Long Name 1: EAGLE EYE FAMILY DEVELOPMENT
Long Name 2: CENTER

Address 1: 4515 NORTH RIDGE ROAD EAST
Address 2:

City: ASHTABULA
Zip Code: 44004
County: ASHT

Contact: CINDY DIBELL
Title: CLERK
Phone: 4409928776
FAX: .

Vendor: 11137

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/08/2011

File Produced: 19MAY2012