UPI (Provider ID): 1212
Change Report (if Any):

Short Name: PROJECT LINDEN

Long Name 1: PROJECT LINDEN
Long Name 2:

Address 1: 1410 CLEVELAND AVENUE SUITE 2
Address 2:

City: COLUMBUS
Zip Code: 43211
County: FRAN

Contact: MICHAEL HARRIS
Title:
Phone: 6142217790
FAX: 6142219164

Vendor: 1212

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/27/2012

File Produced: 19MAY2012