UPI (Provider ID): 13079
Change Report (if Any):

Short Name: TWELVE OF OHIO

Long Name 1: THE TWELVE OF OHIO INC
Long Name 2:

Address 1: 619 TREMONT SW
Address 2:

City: MASSILLON
Zip Code: 44647
County: STAR

Contact: JOHN STOIA
Title: EXDIR
Phone: 3308373555
FAX: 3308370593

Vendor: 13079

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012