UPI (Provider ID): 1117
Change Report (if Any):

Short Name: UMADAOP-YOUNG

Long Name 1: URBAN MINORITY ALCOHOLISM AND
Long Name 2: DRUG ABUSE OUTREACH PROGRAM

Address 1: 1327 FLORENCEDALE AVENUE
Address 2:

City: YOUNGSTOWN
Zip Code: 44505
County: MAHO

Contact: GERALDINE SHERWOOD
Title: FISC
Phone: 3307432772
FAX: 3307432238

Vendor: 1117

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/31/2012

File Produced: 19MAY2012