UPI (Provider ID): 12394
Change Report (if Any):

Short Name: BUCKHORN

Long Name 1: BUCKHORN CHILDREN AND FAMILY
Long Name 2: SERVICES

Address 1: 7130 COUNTY LINE ROAD 121
Address 2:

City: CHESTERVILLE
Zip Code: 43317
County: DELA

Contact: KIM ROBINSON
Title: CFO
Phone: 4197682225
FAX: 4197682118

Vendor: 12394

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/09/2011

File Produced: 19MAY2012