UPI (Provider ID): 12775
Change Report (if Any):

Short Name: COMP PSYCHIATRY

Long Name 1: COMPREHENSIVE PSYCHIATRY GROUP
Long Name 2:

Address 1: 955 WINDHAM COURT SUITE 2
Address 2:

City: BOARDMAN
Zip Code: 44512
County: MAHO

Contact: LAURIE GARMAN
Title: DBO
Phone: 3307269570
FAX: 3308841928

Vendor: 12775

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012