MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 12187
Change Report (if Any):

Short Name: TFJ INC

Long Name 1: THERESA FOSTER JOHNSON INC
Long Name 2:

Address 1: 603 BELMONT AVENUE
Address 2:

City: TOLEDO
Zip Code: 43602
County: LUCA

Contact: THERESA FOSTER JOHNS
Title: EXDIR
Phone: 4192421775
FAX: 4192425211

Vendor: 12187

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012