UPI (Provider ID): 12716
Change Report (if Any):

Short Name: NAMI OF CLARK

Long Name 1: NAMI OF CLARK COUNTY
Long Name 2:

Address 1: 224 EAST STREET
Address 2:

City: SPRINGFIELD
Zip Code: 45505
County: CLAR

Contact: JASON SHERROCK
Title: COORD
Phone: 9373221678
FAX: .

Vendor: 12716

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012