MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 12419
Change Report (if Any):

Short Name: SOUTHRN OH MUSK

Long Name 1: SOUTHERN OHIO SOLUTIONS INC
Long Name 2:

Address 1: 331 THIRD STREET
Address 2:

City: MARIETTA
Zip Code: 45750
County: WASH

Contact: AMY SEE
Title:
Phone: 7403743455
FAX: 7403743474

Vendor: 12419

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012