UPI (Provider ID): 13009
Change Report (if Any):

Short Name: LENZY FAMILY

Long Name 1: LENZY FAMILY
Long Name 2:

Address 1: 3757 CLEVELAND AVENUE NW
Address 2:

City: CANTON
Zip Code: 44709
County: STAR

Contact: ELIZABETH LENZY
Title: EXDIR
Phone: 3309565623
FAX: 3309565936

Vendor: 13009

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/30/2012

File Produced: 19MAY2012