UPI (Provider ID): 2961
Change Report (if Any):

Short Name: LUCAS TASC

Long Name 1: LUCAS COUNTY TASC
Long Name 2:

Address 1: 701 JEFFERSON AVENUE
Address 2: SUITE 101

City: TOLEDO
Zip Code: 43604
County: LUCA

Contact: JOHNETTA MCCOLOGH
Title: EX DR
Phone: 4192429955
FAX: 4192428855

Vendor: 2961

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012