UPI (Provider ID): 1221
Change Report (if Any):

Short Name: WOODLAND-GALL

Long Name 1: WOODLAND CENTERS INC
Long Name 2:

Address 1: 3086 STATE ROUTE 160
Address 2:

City: GALLIPOLIS
Zip Code: 456318409
County: GALL

Contact: LOUELLA STOVER
Title: FISC
Phone: 7404465500
FAX: 7404464402

Vendor: 1221

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/13/2011

File Produced: 19MAY2012