UPI (Provider ID): 13218
Change Report (if Any):

Short Name: COMMUNITY

Long Name 1: COMMUNITY COUNSELING AND
Long Name 2: TREATMENT SERVICES INC

Address 1: 4282 STATE ROUTE 93
Address 2:

City: IRONTON
Zip Code: 45638
County: LAWR

Contact: MIKE FRAULINI
Title: EXDIR
Phone: 7402374595
FAX: 7402374597

Vendor: 60107

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 04/02/2012

File Produced: 19MAY2012