UPI (Provider ID): 1138
Change Report (if Any):

Short Name: MAUMEE VALLEY

Long Name 1: MAUMEE VALLEY GUIDANCE CENTER
Long Name 2:

Address 1: 211 BIEDE AVENUE
Address 2:

City: DEFIANCE
Zip Code: 43512
County: DEFI

Contact: WILLIAM BIERIE
Title: ADMN
Phone: 4197828856
FAX: 4197844506

Vendor: 1138

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/23/2012

File Produced: 19MAY2012