UPI (Provider ID): 1148
Change Report (if Any):

Short Name: UMADAOP-WARREN

Long Name 1: URBAN MINORITY ALCOHOLISM AND
Long Name 2: DRUG ABUSE OUTREACH PROGRAM

Address 1: 4087 YOUNGSTOWN WARREN ROAD
Address 2:

City: WARREN
Zip Code: 44484
County: TRUM

Contact: BEVERLY JEAN POLLARD
Title: DIR
Phone: 3303943044
FAX: 3303933048

Vendor: 1148

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012