UPI (Provider ID): 2926
Change Report (if Any):

Short Name: ANTHONY WAYNE

Long Name 1: ANTHONY WAYNE SYLVANIA SCHOOLS
Long Name 2: DARE PROJECT

Address 1: 11012 SHEPLER AVENUE
Address 2:

City: WHITEHOUSE
Zip Code: 43571
County: LUCA

Contact: RICHARD HEINTSCHEL
Title: EXDIR
Phone: 4198248588
FAX: 4198246953

Vendor: 2926

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012