UPI (Provider ID): 13040
Change Report (if Any):

Short Name: MARION-CRW PREV

Long Name 1: MARION CRAWFORD PREVENTION
Long Name 2: PROGRAMS

Address 1: 142 SOUTH PROSPECT STREET
Address 2:

City: MARION
Zip Code: 43302
County: MARI

Contact: JODI GALLOWAY
Title: CEO
Phone: 7403878531
FAX: 7403820455

Vendor: 13040

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012