UPI (Provider ID): 12656
Change Report (if Any):

Short Name: DIVERSIFIED COM

Long Name 1: DIVERSIFIED COMMUNITY SERVICES
Long Name 2:

Address 1: 479 SEYMOUR AVENUE
Address 2:

City: COLUMBUS
Zip Code: 43205
County: FRAN

Contact: FRED BORGER
Title: PRES
Phone: 6142538444
FAX: 6142526787

Vendor: 3326

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012