UPI (Provider ID): 12533
Change Report (if Any):

Short Name: MAHAJAN

Long Name 1: MAHAJAN THERAPEUTICS
Long Name 2:

Address 1: 6300 NORTH MAIN STREET
Address 2:

City: DAYTON
Zip Code: 45415
County: MONT

Contact: USHA MAHAJAN
Title: DIR
Phone: 9378367666
FAX: 9378321168

Vendor: 12533

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012