UPI (Provider ID): 1220
Change Report (if Any):

Short Name: FAM ADD-GALL

Long Name 1: FACTS NEW ALTERNATIVES
Long Name 2:

Address 1: 45 OLIVE STREET
Address 2:

City: GALLIPOLIS
Zip Code: 45631
County: GALL

Contact: TERRIE MATHEWS
Title: DIR
Phone: 7404467866
FAX: 7404468014

Vendor: 1220

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/27/2012

File Produced: 19MAY2012