UPI (Provider ID): 1144
Change Report (if Any):

Short Name: DELAWARE-RECOV

Long Name 1: RECOVERY AND PREVENTION
Long Name 2: RESOURCES

Address 1: 118 STOVER DRIVE
Address 2:

City: DELAWARE
Zip Code: 430158634
County: DELA

Contact: TONY WILLIAMS
Title: EX DR
Phone: 7403696811
FAX: 7403638742

Vendor: 1144

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/19/2011

File Produced: 19MAY2012