UPI (Provider ID): 12532
Change Report (if Any):

Short Name: OTHER PLACE

Long Name 1: THE OTHER PLACE
Long Name 2:

Address 1: 816 SOUTH PATTERSON BLVD
Address 2:

City: DAYTON
Zip Code: 45402
County: MONT

Contact: TINA PATTERSON
Title: CEO
Phone: 9374616078
FAX: 9373315286

Vendor: 12532

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012