UPI (Provider ID): 1387
Change Report (if Any):

Short Name: GATEWAY OUTRECH

Long Name 1: GATEWAY OUTREACH CENTER
Long Name 2:

Address 1: 800 PRO DRIVE
Address 2: PO BOX 488

City: CELINA
Zip Code: 458229488
County: MERC

Contact: ALLISON BRADY
Title: EX DR
Phone: 4195864030
FAX: 4195863268

Vendor: 1387

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012