MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 11170
Change Report (if Any):

Short Name: LUCA CO FAM COU

Long Name 1: LUCAS COUNTY FAMILY COUNCIL
Long Name 2:

Address 1: ONE GOVERNMENT CENTER
Address 2: SUITE 580

City: TOLEDO
Zip Code: 43604
County: LUCA

Contact: MARIAN BRANNON
Title:
Phone: 4192136995
FAX: 4192136998

Vendor: 11170

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012