UPI (Provider ID): 11155
Change Report (if Any):

Short Name: WAY STATION

Long Name 1: THE WAY STATION
Long Name 2:

Address 1: 430 WEST FIFTH STREET
Address 2:

City: EAST LIVERPOOL
Zip Code: 43920
County: COLU

Contact: GARY HOLSOPPLE
Title:
Phone: 3303857510
FAX: 3303857530

Vendor: 11155

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012