UPI (Provider ID): 2915
Change Report (if Any):

Short Name: AFRICENTRIC PDS

Long Name 1: AFRICENTRIC PERSONAL
Long Name 2: DEVELOPMENT SHOP

Address 1: 1409 EAST LIVINGSTON AVENUE
Address 2:

City: COLUMBUS
Zip Code: 43205
County: FRAN

Contact: JERRY SAUNDERS
Title: EX DR
Phone: 6142534448
FAX: 6142538781

Vendor: 2915

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/30/2012

File Produced: 19MAY2012