UPI (Provider ID): 1311
Change Report (if Any):

Short Name: FREEDOM CENTER

Long Name 1: ALCOHOL AND DRUG FREEDOM
Long Name 2: CENTER OF KNOX COUNTY

Address 1: 106 EAST GAMBIER STREET
Address 2:

City: MOUNT VERNON
Zip Code: 43050
County: KNOX

Contact: DEBBIE CLINE
Title: MAN
Phone: 7403972660
FAX: 7403923613

Vendor: 1311

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/14/2011

File Produced: 19MAY2012