UPI (Provider ID): 12175
Change Report (if Any):

Short Name: THE MAIN PLACE

Long Name 1: THE MAIN PLACE INC
Long Name 2:

Address 1: 112 SOUTH THIRD STREET
Address 2:

City: NEWARK
Zip Code: 43055
County: LICK

Contact: GLENN HOPKINS
Title: ED
Phone: 7403456246
FAX: 7403453697

Vendor: 12175

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 03/15/2012

File Produced: 19MAY2012