UPI (Provider ID): 12577
Change Report (if Any):

Short Name: MEDICINE WHEEL

Long Name 1: MEDICINE WHEEL HEALING HOUSE
Long Name 2:

Address 1: 287 WEST MAIN STREET
Address 2:

City: XENIA
Zip Code: 45385
County: GREE

Contact: MARK MILLAT
Title: CEO
Phone: 9372995167
FAX: 9372995167

Vendor: 12380

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012