UPI (Provider ID): 12643
Change Report (if Any):

Short Name: ROCKING HORSE

Long Name 1: ROCKING HORSE CENTER
Long Name 2:

Address 1: 651 SOUTH LIMESTONE STREET
Address 2:

City: SPRINGFIELD
Zip Code: 45505
County: CLAR

Contact: JAMES DUFFE
Title: DR
Phone: 9373241111
FAX: 9373223351

Vendor: 12643

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/16/2011

File Produced: 19MAY2012