UPI (Provider ID): 1123
Change Report (if Any):

Short Name: WOMENS REC-GREE

Long Name 1: RECOVERY CENTERS
Long Name 2: WOMENS RECOVERY CENTER

Address 1: 515 MARTIN DRIVE
Address 2:

City: XENIA
Zip Code: 453850580
County: GREE

Contact: MICHELE COX
Title: EX DR
Phone: 9373724777
FAX: 9373728688

Vendor: 1123

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/08/2011

File Produced: 19MAY2012