UPI (Provider ID): 2529
Change Report (if Any):

Short Name: LIFESPAN

Long Name 1: LIFESPAN INCORPORATED
Long Name 2:

Address 1: 1900 FAIRGROVE AVENUE
Address 2:

City: HAMILTON
Zip Code: 45011
County: BUTL

Contact: PHYLLIS BLUST
Title: ADAST
Phone: 5138683210
FAX: 5138677556

Vendor: 2529

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012