UPI (Provider ID): 1942
Change Report (if Any):

Short Name: UMADAOP-LORA

Long Name 1: LORAIN URBAN MINORITY
Long Name 2: ALCOHOLISM DRUG ABUSE OUTREACH

Address 1: 2314 KELLY PLACE
Address 2:

City: LORAIN
Zip Code: 44052
County: LORA

Contact: PABLO BURBANO
Title: ASSOC
Phone: 4402464616
FAX: 4402461997

Vendor: 1942

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/15/2012

File Produced: 19MAY2012