UPI (Provider ID): 12184
Change Report (if Any):

Short Name: SPEC CARE COUNS

Long Name 1: SPECIALTY CARE COUNSELING
Long Name 2: SERVICES

Address 1: 2000 EAST MARKET STREET
Address 2:

City: WARREN
Zip Code: 44483
County: TRUM

Contact: NIVINE SEDRA
Title: ASDIR
Phone: 3303991221
FAX: 3303991205

Vendor: 12184

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/28/2011

File Produced: 19MAY2012