UPI (Provider ID): 1433
Change Report (if Any):

Short Name: PICKAWAY RECOV

Long Name 1: PICKAWAY AREA RECOVERY
Long Name 2: SERVICES

Address 1: 319 LOGAN STREET
Address 2:

City: CIRCLEVILLE
Zip Code: 43113
County: PICK

Contact: BARRY BENNETT
Title: DIR
Phone: 7404771745
FAX: 7404772779

Vendor: 1433

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/25/2012

File Produced: 19MAY2012