UPI (Provider ID): 2955
Change Report (if Any):

Short Name: EASTSIDE PROG

Long Name 1: EASTSIDE PROGRAM AGAINST
Long Name 2: SUBSTANCE ABUSE

Address 1: 3450 MEDWAY AVENUE
Address 2:

City: COLUMBUS
Zip Code: 43213
County: FRAN

Contact: PHILLIP HOBBS
Title: EXDIR
Phone: 6143656166
FAX: 6148906072

Vendor: 2955

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012