UPI (Provider ID): 1513
Change Report (if Any):

Short Name: REBECA WILLIAMS

Long Name 1: REBECCA WILLIAMS
Long Name 2: COMMUNITY CENTER

Address 1: 421 MAIN AVENUE SW
Address 2:

City: WARREN
Zip Code: 44481
County: TRUM

Contact: JEAN FORBES
Title: DIR
Phone: 3303998931
FAX: 3303998933

Vendor: 1513

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012