UPI (Provider ID): 3164
Change Report (if Any):

Short Name: HUCK HOUSE

Long Name 1: HUCKLEBERRY HOUSE INC
Long Name 2:

Address 1: 1421 HAMLET STREET
Address 2:

City: COLUMBUS
Zip Code: 43201
County: FRAN

Contact: LYNDA LECLERC
Title: DIR
Phone: 6142948097
FAX: 6142946109

Vendor: 3164

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/23/2011

File Produced: 19MAY2012