UPI (Provider ID): 13014
Change Report (if Any):

Short Name: QUEEN CENTERS

Long Name 1: QUEEN TREATMENT CENTERS INC
Long Name 2:

Address 1: 10 LADY AVENUE
Address 2:

City: JACKSON
Zip Code: 45640
County: JACK

Contact: YOLANDA QUEEN
Title: EXDIR
Phone: 7405773334
FAX: 7405723424

Vendor: 13014

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012