UPI (Provider ID): 12847
Change Report (if Any):

Short Name: YOUTH ADVOCATE

Long Name 1: YOUTH ADVOCATE SERVICES
Long Name 2:

Address 1: 965 EAST BROAD STREET
Address 2:

City: COLUMBUS
Zip Code: 43205
County: FRAN

Contact: TRACEY IZZARD
Title: CEO
Phone: 6142589927
FAX: 6142585719

Vendor: 12847

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/14/2011

File Produced: 19MAY2012