UPI (Provider ID): 1342
Change Report (if Any):

Short Name: COURT DIAGNOSTC

Long Name 1: COURT DIAGNOSTIC AND
Long Name 2: TREATMENT CENTER

Address 1: 1946 N 13TH STREET
Address 2: SUITE 230

City: TOLEDO
Zip Code: 43604
County: LUCA

Contact: JUDDY FORGAC
Title: EX DR
Phone: 4192448624
FAX: 4192449213

Vendor: 1342

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/21/2012

File Produced: 19MAY2012