UPI (Provider ID): 12408
Change Report (if Any):

Short Name: ADV INJURY MGMT

Long Name 1: ADVANCED INJURY MANAGEMENT
Long Name 2:

Address 1: 9586 IRELAND COURT
Address 2:

City: POWELL
Zip Code: 43065
County: DELA

Contact: SHEILA HOKES
Title: ADM
Phone: 6143362664
FAX: 6143362665

Vendor: 12408

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012