UPI (Provider ID): 1454
Change Report (if Any):

Short Name: PATHWAYS-LOCUST

Long Name 1: PATHWAYS COUNSELING CENTER
Long Name 2:

Address 1: 835 NORTH LOCUST STREET
Address 2:

City: OTTAWA
Zip Code: 45875
County: PUTN

Contact: ROBERT WILLIAMS
Title: EX DR
Phone: 4195234300
FAX: 4195236188

Vendor: 1454

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/02/2012

File Produced: 19MAY2012