UPI (Provider ID): 12642
Change Report (if Any):

Short Name: NORTHLAND CNTR

Long Name 1: HEALTHCARE VENTURE PARTNERS
Long Name 2: DBA NORTHLAND INTERVENTION CNT

Address 1: 37 EAST MAIN STREET
Address 2:

City: AMELIA
Zip Code: 45102
County: CLER

Contact: LORI BROOKBANK
Title: CFO
Phone: 5137539964
FAX: 5137539968

Vendor: 12642

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/10/2011

File Produced: 19MAY2012