UPI (Provider ID): 1258
Change Report (if Any):

Short Name: CROSSROADS CNTR

Long Name 1: THE CROSSROADS CENTER
Long Name 2:

Address 1: 311 MARTIN LUTHER KING DRIVE
Address 2:

City: CINCINNATI
Zip Code: 45220
County: HAMI

Contact: ROKHAYA SEYE
Title: VP
Phone: 5134755300
FAX: 5132811645

Vendor: 1258

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/04/2012

File Produced: 19MAY2012