UPI (Provider ID): 12682
Change Report (if Any):

Short Name: NECCO

Long Name 1: NECCO
Long Name 2:

Address 1: 115 PRIVATE RD 977 CO RD 44 N
Address 2:

City: PEDRO
Zip Code: 45659
County: LAWR

Contact: BOB CARPENTER
Title: EXDIR
Phone: 7405341386
FAX: 7405340577

Vendor: 12682

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/05/2012

File Produced: 19MAY2012