UPI (Provider ID): 11188
Change Report (if Any):

Short Name: TASC OF SE OHIO

Long Name 1: TASC OF SOUTHEAST OHIO
Long Name 2:

Address 1: 499 JACKSON PIKE SUITE F
Address 2: PO BOX 88

City: GALLIPOLIS
Zip Code: 45631
County: GALL

Contact: STEVE THOMAS
Title: EXDIR
Phone: 7404466471
FAX: 7404467894

Vendor: 8184

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/29/2012

File Produced: 19MAY2012