UPI (Provider ID): 1234
Change Report (if Any):

Short Name: GUERNSEY HEALTH

Long Name 1: ALCOHOL AND DRUG SERVICES OF
Long Name 2: GUERSNEY COUNTY

Address 1: 927 WHEELING AVENUE SUITE 310
Address 2:

City: CAMBRIDGE
Zip Code: 437252349
County: GUER

Contact: LINDA SECREST
Title: EX DR
Phone: 7404394532
FAX: 7404391031

Vendor: 1234

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012