UPI (Provider ID): 1161
Change Report (if Any):
Short Name: CONCORD
Long Name 1: CONCORD COUNSELING SERVICES
Long Name 2:
Address 1: 774 PARK MEADOW ROAD
Address 2:
City: WESTERVILLE
Zip Code: 43081
County: FRAN
Contact: MARY SOMMER
Title: EX DR
Phone: 6148829338
FAX: 6148823401
Vendor: 1161
Reports Status: CLAIMS/BH
MACSIS Last Update Date: 12/08/2011
File Produced: 19MAY2012