UPI (Provider ID): 1267
Change Report (if Any):

Short Name: ALCOHOLISM COUN

Long Name 1: ALCOHOLISM COUNCIL OF GREATER
Long Name 2: CINCINNATI AREA NCADD

Address 1: 2828 VERNON PLACE
Address 2: FL 2

City: CINCINNATI
Zip Code: 45219
County: HAMI

Contact: JOHN BILLERMAN
Title: MIS
Phone: 5132817880
FAX: 5132817884

Vendor: 1267

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/20/2012

File Produced: 19MAY2012